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Calcitonin Gene-related Peptide Levels in Chronic Migraine

Primary Purpose

Chronic Migraine

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
OnabotulinumtoxinA
Saline
Sponsored by
Cady, Roger, M.D.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Migraine focused on measuring Botox, OnabotulinumtoxinA, Chronic Migraine, Calcitonin Gene-Related Peptide, Saliva

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • must be outpatient, male or female, of any race, between 18 and 65 years of age.
  • if female of childbearing potential must have negative pregnancy test result at Screening Visit and practice reliable method of contraception.

A female is considered of childbearing potential unless she is post menopausal for at least 12 months prior to administration of study drug, without a uterus and/or both ovaries or has been surgically sterilized for at least 6 months prior to study drug administration.

Reliable methods of contraception are: Complete abstinence from intercourse from 2 weeks prior to administration of the investigational product, throughout the study, and for a time interval (5 days) after completion or premature discontinuation from the study; or, History of bilateral tubal ligation; or, Sterilization of male partner; or, Implants of levonorgestrel; or, Injectable progestogen; or, Oral contraceptive (combination therapy with ethinyl estradiol plus a progestin) with a placebo week every 1-3 months; or, Any intrauterine device (IUD) with published data showing that the highest expected failure rate is less than 1% per year (not all IUD's meet this criterion) in use at least 30 days prior to study drug administration; or, Spermicide plus a mechanical barrier (e.g., spermicide plus a male condom or a female diaphragm); or, Any other barrier methods (only is used in combination with any of the above acceptable methods) in use at least 14 days prior to study drug administration; or, Any other methods with published data showing that the highest expected failure rate for that methods is less than 1% per year.

  • must have history of chronic migraine (with or without aura) according to the criteria proposed by the Headache Classification Committee of the International Headache Society (IHS) for at least 3 months prior to enrollment.
  • must be able to understand the requirements of the study including maintaining a headache Diary, and signing informed consent.
  • must be in good general health as determined by investigator.
  • if taking migraine preventive, must be on a stable dose of preventive medication for at least 3 months prior to screening.

Exclusion Criteria:

  • if female, is pregnant, planning to become pregnant during the study period, is breast feeding, or is of childbearing potential and not practicing a reliable form of birth control.
  • has headache disorders outside IHS-defined chronic migraine definition.
  • has evidence of underlying pathology contributing to their headaches.
  • has any pathology of the salivary glands such as sialadenitis (e.g. Sjogren's syndrome, viral or bacterial sialadenitis) or condition or symptom that would alter the content of saliva.
  • has any medical condition that may increase their risk with exposure to OnabotulinumtoxinA including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other significant disease that might interfere with neuromuscular function.
  • has profound atrophy or weakness of muscles in the target areas of injection.
  • has skin conditions or infections at any of the injection sites.
  • has allergy or sensitivities to any component of the test medication.
  • who in the opinion of the investigator, has active major psychiatric or depressive disorders including alcohol/drug abuse.
  • meets International Headache Society criteria for Medication Overuse with opioid or butalbital containing products.
  • is planning or requiring surgery during the study.
  • has a history of poor compliance with medical treatment.
  • is currently participating in an investigational drug study or has participated in an investigational drug study within the previous 30 days of the screening visit.

Sites / Locations

  • Clinvest
  • Island Neurological Associates, P.C.

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

OnabotulinumtoxinA

Saline

Arm Description

Minimum dose of 155 international units (U) OnabotulinumtoxinA Purified Neurotoxin Complex administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas.

155 U Saline administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas.

Outcomes

Primary Outcome Measures

Change in Number of Headache Days Per Month From Baseline (BL) to Months 1 Through 7.
Baseline number of headache days per month collected historically at screening. Post-treatment number of headache days collected per month via diary.
Change in Number of Headache Days Per Month From Baseline to Month 1 (M1), Month 1 to Month 2 (M2), and Month 2 to Month 3 (M3).
Baseline number of headache days per month collected historically at screening. Post-treatment number of headache days collected per month via diary.

Secondary Outcome Measures

Inter-ictal (Baseline) Levels of Saliva Calcitonin Gene-related Peptide (CGRP)
CGRP Level collected each month when subject did not have a headache or was at lowest pain level of headache that month.
Saliva CGRP Levels for OnabotulinumtoxinA Responders (Reduction of Headache Days Greater Than 30%) vs. Non-responders and Saline
Saliva samples collected at Baseline (at no headache or lowest level of headache), at headache attack directly before taking rescue medication and 2 hours after treating with rescue medication.
Changes Between Inter-ictal (Baseline) Levels Between Responders and Non-responders
Only cytokines with a mean densimetric value 1.65 times the background grey value in a minimum of 3 patients were considered detectable. These are reported below. Values normalized to positive control array spots after background subtraction: C5/C5a, CD40 Ligand, Granulocyte Colony Stimulating Factor (G-CSF), Growth Regulated Oncogene(GRO)-alpha, Soluble Intercellular Adhesion Molecule (sICAM)-1, Interferon gamma (IFN-y), Interleukin(IL)-1alpha, 1beta, 1ra, 8, 16, 17E, & 23, Interferon Gamma-Induced Protein 10 (IP-10), Interferon-inducible T cell alpha chemoattractant (I-TAC), Macrophage Migration Inhibitory Factor (MIF), Serpin E1, and Regulated Upon Activation Normal T-cell Expressed (RANTES)

Full Information

First Posted
February 17, 2010
Last Updated
February 6, 2013
Sponsor
Cady, Roger, M.D.
Collaborators
Allergan
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1. Study Identification

Unique Protocol Identification Number
NCT01071096
Brief Title
Calcitonin Gene-related Peptide Levels in Chronic Migraine
Official Title
Calcitonin Gene-related Peptide (CGRP) Levels in the Pathogenesis of Chronic Migraine
Study Type
Interventional

2. Study Status

Record Verification Date
February 2013
Overall Recruitment Status
Completed
Study Start Date
June 2010 (undefined)
Primary Completion Date
June 2011 (Actual)
Study Completion Date
June 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cady, Roger, M.D.
Collaborators
Allergan

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Twenty patients will be enrolled in a 2-site, 7-month, double-blind study conducted to evaluate a reduction in headache days and attacks and calcitonin gene-related peptide (CGRP) levels in saliva following treatment with OnabotulinumtoxinA versus saline. Eligible patients will be randomized and receive injections of OnabotulinumtoxinA or Saline at Visit 1. Following 3 months plus a 1 month wash out, patients will receive cross-over injections at Visit 5. Patients will return for monthly visits and exit the study at Visit 8. Patients will collect saliva at monthly intervals and document in a daily headache diary throughout the study .
Detailed Description
This double-blind study will evaluate reduction in number of headache days following treatment with OnabotulinumtoxinA versus Saline. Additionally, CGRP levels in saliva will be correlated with a reduction in headache attacks. At Visit 1, eligible subjects will be randomized 1:1 to receive injections of OnabotulinumtoxinA or Saline in an identical manner. Subjects will collect 3 saliva samples during each month of the 7 month study: 1 collection at Baseline headache level, 1 collection at onset of headache that is one degree worse than Baseline level that will be treated with acute therapy, and 1 collection at 2 hours following treatment. Subjects will document headache and headache symptoms in a daily diary and return to the clinic with diary and saliva samples at monthly visits. Following 4 months (including a 1 month washout after Visit 4), subjects will return at Visit 5 and receive cross-over injections. Subjects randomized to OnabotulinumtoxinA at Visit 1 will receive injections of Saline. Subjects randomized to saline at Visit 1 will receive injections of OnabotulinumtoxinA. Subjects will document headache and headache symptoms in a daily diary and return to the clinic with diary and saliva samples at monthly visits. At Visit 8, 3 months following re-injection at Visit 5, subjects will exit the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Migraine
Keywords
Botox, OnabotulinumtoxinA, Chronic Migraine, Calcitonin Gene-Related Peptide, Saliva

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
OnabotulinumtoxinA
Arm Type
Active Comparator
Arm Description
Minimum dose of 155 international units (U) OnabotulinumtoxinA Purified Neurotoxin Complex administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas.
Arm Title
Saline
Arm Type
Placebo Comparator
Arm Description
155 U Saline administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas.
Intervention Type
Drug
Intervention Name(s)
OnabotulinumtoxinA
Other Intervention Name(s)
Botulinum Toxin Type A Purified Neurotoxin Complex, Botox
Intervention Description
Minimum dose of 155 U OnabotulinumtoxinA Purified Neurotoxin Complex administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas. Subjects will continue to monitor headache symptoms with a headache diary and collect saliva samples as instructed. At investigator's discretion, additional 40 U OnabotulinumtoxinA Purified Neurotoxin Complex may be administered unilaterally or bilaterally, using follow-the-pain paradigm.
Intervention Type
Drug
Intervention Name(s)
Saline
Other Intervention Name(s)
Placebo
Intervention Description
155 U Saline administered at 31 fixed-site, fixed-dose injections across seven specific head/neck muscle areas. Subjects will continue to monitor headache using a headache diary and collect saliva samples as instructed. At investigator's discretion, additional Saline may be administered unilaterally or bilaterally, using follow-the-pain paradigm.
Primary Outcome Measure Information:
Title
Change in Number of Headache Days Per Month From Baseline (BL) to Months 1 Through 7.
Description
Baseline number of headache days per month collected historically at screening. Post-treatment number of headache days collected per month via diary.
Time Frame
Baseline (collected historically at screening) versus (vs.) Month (Mo) 1, Mo 2, Mo 3, Mo 4, Mo 5, Mo 6, and Mo 7
Title
Change in Number of Headache Days Per Month From Baseline to Month 1 (M1), Month 1 to Month 2 (M2), and Month 2 to Month 3 (M3).
Description
Baseline number of headache days per month collected historically at screening. Post-treatment number of headache days collected per month via diary.
Time Frame
Baseline (collected historically at screening) vs. Mo 1, Mo 1 vs. Mo 2, Mo 2 vs. Mo 3, Mo 3 vs. Mo 4, Mo 4 vs. Mo 5, Mo 5 vs. Mo 6, and Mo 6 vs. Mo 7
Secondary Outcome Measure Information:
Title
Inter-ictal (Baseline) Levels of Saliva Calcitonin Gene-related Peptide (CGRP)
Description
CGRP Level collected each month when subject did not have a headache or was at lowest pain level of headache that month.
Time Frame
Baseline levels collected for OnabotulinumtoxinA and Saline treatment during Months 1 through 7
Title
Saliva CGRP Levels for OnabotulinumtoxinA Responders (Reduction of Headache Days Greater Than 30%) vs. Non-responders and Saline
Description
Saliva samples collected at Baseline (at no headache or lowest level of headache), at headache attack directly before taking rescue medication and 2 hours after treating with rescue medication.
Time Frame
For OnabotulinumtoxinA and Saline treatment months 1, 2 and 3
Title
Changes Between Inter-ictal (Baseline) Levels Between Responders and Non-responders
Description
Only cytokines with a mean densimetric value 1.65 times the background grey value in a minimum of 3 patients were considered detectable. These are reported below. Values normalized to positive control array spots after background subtraction: C5/C5a, CD40 Ligand, Granulocyte Colony Stimulating Factor (G-CSF), Growth Regulated Oncogene(GRO)-alpha, Soluble Intercellular Adhesion Molecule (sICAM)-1, Interferon gamma (IFN-y), Interleukin(IL)-1alpha, 1beta, 1ra, 8, 16, 17E, & 23, Interferon Gamma-Induced Protein 10 (IP-10), Interferon-inducible T cell alpha chemoattractant (I-TAC), Macrophage Migration Inhibitory Factor (MIF), Serpin E1, and Regulated Upon Activation Normal T-cell Expressed (RANTES)
Time Frame
For OnabotulinumtoxinA and Saline treatment months 1, 2 and 3 at Baseline level (inter-ictal) and at onset of headache that is one degree worse than Baseline level and that will be treated with acute therapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: must be outpatient, male or female, of any race, between 18 and 65 years of age. if female of childbearing potential must have negative pregnancy test result at Screening Visit and practice reliable method of contraception. A female is considered of childbearing potential unless she is post menopausal for at least 12 months prior to administration of study drug, without a uterus and/or both ovaries or has been surgically sterilized for at least 6 months prior to study drug administration. Reliable methods of contraception are: Complete abstinence from intercourse from 2 weeks prior to administration of the investigational product, throughout the study, and for a time interval (5 days) after completion or premature discontinuation from the study; or, History of bilateral tubal ligation; or, Sterilization of male partner; or, Implants of levonorgestrel; or, Injectable progestogen; or, Oral contraceptive (combination therapy with ethinyl estradiol plus a progestin) with a placebo week every 1-3 months; or, Any intrauterine device (IUD) with published data showing that the highest expected failure rate is less than 1% per year (not all IUD's meet this criterion) in use at least 30 days prior to study drug administration; or, Spermicide plus a mechanical barrier (e.g., spermicide plus a male condom or a female diaphragm); or, Any other barrier methods (only is used in combination with any of the above acceptable methods) in use at least 14 days prior to study drug administration; or, Any other methods with published data showing that the highest expected failure rate for that methods is less than 1% per year. must have history of chronic migraine (with or without aura) according to the criteria proposed by the Headache Classification Committee of the International Headache Society (IHS) for at least 3 months prior to enrollment. must be able to understand the requirements of the study including maintaining a headache Diary, and signing informed consent. must be in good general health as determined by investigator. if taking migraine preventive, must be on a stable dose of preventive medication for at least 3 months prior to screening. Exclusion Criteria: if female, is pregnant, planning to become pregnant during the study period, is breast feeding, or is of childbearing potential and not practicing a reliable form of birth control. has headache disorders outside IHS-defined chronic migraine definition. has evidence of underlying pathology contributing to their headaches. has any pathology of the salivary glands such as sialadenitis (e.g. Sjogren's syndrome, viral or bacterial sialadenitis) or condition or symptom that would alter the content of saliva. has any medical condition that may increase their risk with exposure to OnabotulinumtoxinA including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other significant disease that might interfere with neuromuscular function. has profound atrophy or weakness of muscles in the target areas of injection. has skin conditions or infections at any of the injection sites. has allergy or sensitivities to any component of the test medication. who in the opinion of the investigator, has active major psychiatric or depressive disorders including alcohol/drug abuse. meets International Headache Society criteria for Medication Overuse with opioid or butalbital containing products. is planning or requiring surgery during the study. has a history of poor compliance with medical treatment. is currently participating in an investigational drug study or has participated in an investigational drug study within the previous 30 days of the screening visit.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roger K Cady, MD
Organizational Affiliation
Clinvest
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clinvest
City
Springfield
State/Province
Missouri
ZIP/Postal Code
65807
Country
United States
Facility Name
Island Neurological Associates, P.C.
City
Plainview
State/Province
New York
ZIP/Postal Code
11803
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
16412148
Citation
Bellamy JL, Cady RK, Durham PL. Salivary levels of CGRP and VIP in rhinosinusitis and migraine patients. Headache. 2006 Jan;46(1):24-33. doi: 10.1111/j.1526-4610.2006.00294.x.
Results Reference
background
PubMed Identifier
19788468
Citation
Cady RK, Vause CV, Ho TW, Bigal ME, Durham PL. Elevated saliva calcitonin gene-related peptide levels during acute migraine predict therapeutic response to rizatriptan. Headache. 2009 Oct;49(9):1258-66. doi: 10.1111/j.1526-4610.2009.01523.x.
Results Reference
background
PubMed Identifier
14979881
Citation
Durham PL, Cady R, Cady R. Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache. 2004 Jan;44(1):35-42; discussion 42-3. doi: 10.1111/j.1526-4610.2004.04007.x.
Results Reference
background
PubMed Identifier
17876959
Citation
Bruno PP, Carpino F, Carpino G, Zicari A. An overview on immune system and migraine. Eur Rev Med Pharmacol Sci. 2007 Jul-Aug;11(4):245-8.
Results Reference
background
PubMed Identifier
15985111
Citation
Perini F, D'Andrea G, Galloni E, Pignatelli F, Billo G, Alba S, Bussone G, Toso V. Plasma cytokine levels in migraineurs and controls. Headache. 2005 Jul-Aug;45(7):926-31. doi: 10.1111/j.1526-4610.2005.05135.x.
Results Reference
background
PubMed Identifier
15546258
Citation
Sarchielli P, Alberti A, Vaianella L, Pierguidi L, Floridi A, Mazzotta G, Floridi A, Gallai V. Chemokine levels in the jugular venous blood of migraine without aura patients during attacks. Headache. 2004 Nov-Dec;44(10):961-8. doi: 10.1111/j.1526-4610.2004.04189.x.
Results Reference
background
PubMed Identifier
11576199
Citation
Munno I, Marinaro M, Bassi A, Cassiano MA, Causarano V, Centonze V. Immunological aspects in migraine: increase of IL-10 plasma levels during attack. Headache. 2001 Sep;41(8):764-7. doi: 10.1046/j.1526-4610.2001.01140.x.
Results Reference
background

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Calcitonin Gene-related Peptide Levels in Chronic Migraine

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