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A Two-Arm Study Evaluation H.P. Acthar Injection Gel in Treatment of Chronic Migraines

Primary Purpose

Chronic Migraine

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
H.P. Acthar Gel
Sponsored by
Dent Neuroscience Research Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Migraine focused on measuring Chronic Migraine, Headache, Refractory Chronic Migraine

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Is male or female, 18 to 60 years of age.
  • Has a history of chronic migraine as classified by the International Headache Classification, ICHD-2R (i.e. must demonstrate an average of >=15 headache days per month, of which >=8 must be migraine days or >=8 days of migraine-specific acute medication-ergotamine or triptans for at least 3 months prior to study.
  • Must demonstrate at least >=8 migraine days or >=8 days of migraine specific acute medications- ergotamine or triptans during 30 day baseline screening.
  • Is able to differentiate migraine from any other headache they may experience (e.g., tension-type headache).
  • Will have a previous history of failing at least one prophylactic treatment, which can include anti-seizure medications and/or TCA's prescribed for the treatment of chronic migraine.
  • Must be considered a non-responder to previous treatment with Botox. Botox failure will be defined by previous documentation (at the discretion of the PI) or as having less than 30% reduction of headache days per month on Botox.
  • Will have not had botulinum toxin with in 4 months before study enrollment.
  • If female of childbearing potential, will have a negative urine pregnancy test at Visits 1 and 7, and uses, or agrees to use, for the duration of the study, a medically acceptable form of contraception as determined by the investigator.

    1. Complete abstinence from intercourse from 2 weeks prior to administration of study drug throughout the study, and for a time interval after completion or premature discontinuation from the study to account for elimination of the study drug (a minimum of 7 days); or,
    2. Surgically sterile (hysterectomy or tubal ligation or otherwise incapable of pregnancy); or,
    3. Sterilization of male partner; or,
    4. Intrauterine device with published data showing lowest expected failure rate is less than 1% per year; or,
    5. Double barrier method (i.e., 2 physical barriers OR 1 physical barrier plus spermicide) for a least 1 month prior to Visit 1 and throughout study; or,
    6. Hormonal contraceptives for at least 3 months prior to Visit 1 and throughout study. Protocol Number/v.1/06 Jun 2012 7
  • Must be in generally good health as confirmed by medical history, baseline physical exam, baseline neurological exam and vital signs.

Exclusion Criteria:

  • Is unable to understand the study requirements, the informed consent, or complete headache records as required per protocol.
  • Is pregnant, actively trying to become pregnant, or breast-feeding.
  • Has a significant systemic disease that is equally painful or more painful than migraine.
  • Has a progressive neurological disorder such as MS.
  • Has a history of chronic disease of the immune system other than MS or a known immunodeficiency syndrome such as HIV.
  • Has sensitivity to proteins of porcine origin.
  • Has a known or 'new' diagnosis of diabetes mellitus (if screening blood glucose is suspicious for diabetes [> or equal to 126 mg/dL or > or equal to 7 mmol/L if fasting;> or equal to 200 mg/dL or 11.1 mmol/L if random testing] a patient should be further evaluated for diabetes mellitus), or a known or 'new' diagnosis of hypothyroidism not adequately controlled with medication.
  • Has previously taken Acthar for any reason.
  • Has any contraindications listed on the Acthar PI.
  • Has a history of cluster headache, chronic tension type headache, or headache due to medication over use according to IHS guidelines, in the 3 months prior to study enrollment or during the baseline phase.
  • Has received any other investigative drug 30 days prior to enrollment in this study.
  • Who in the opinion of the Principal Investigator has a condition for which they should not be enrolled in the study.

Sites / Locations

  • Clinvest/A Division of Banyan Group, Inc.
  • Renown Institute of Neurosciences
  • Dent Neurologic Institute
  • Baylor University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

H.P. Acthar Gel 80IU

H.P. Acthar Gel 40IU

Arm Description

H.P. Acthar Gel of 80IU (1.0 ml)

H.P. Acthar Gel of 40IU (0.5 mL)

Outcomes

Primary Outcome Measures

Average total number of headache days (both 40IU and 80IU groups)
Comparison of the average total number of headache days after 30 days of Acthar treatment (both 40IU and 80IU groups)with the average number of headache days at baseline screening period

Secondary Outcome Measures

Total number of headache days (both 40IU and 80IU groups)
Comparison of the total number of headache days after 30 days of Acthar treatment (both 40IU and 80IU groups) with the number of headache days at baseline screening period

Full Information

First Posted
March 15, 2013
Last Updated
July 23, 2018
Sponsor
Dent Neuroscience Research Center
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1. Study Identification

Unique Protocol Identification Number
NCT01813591
Brief Title
A Two-Arm Study Evaluation H.P. Acthar Injection Gel in Treatment of Chronic Migraines
Official Title
A Randomized, Open-Label, Parallel Two-Arm Study Evaluating the Efficacy of H.P. Acthar Injection Gel in the Treatment of Adults With Intractable Chronic Migraine
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
April 2013 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
November 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dent Neuroscience Research Center

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This small study is to investigate the efficacy of Acthar in the treatment of chronic migraine in patients who have failed multiple treatments, including Botox (which is defined as having <30% reduction from baseline in the number of headache days per month). Despite the widespread use of anti-seizure medications, there remain a significant number of patient whose migraines are refractory to these agents. The pathophysiology of migraine is such that the neural substances calcitonin G related protein (CGRP), substance P, and neurokinin A are released at the trigeminal nerve endings innervating the large cranial and dura mater blood vessels and this neurotrasmission generates migraine associated pain. Because of this, treatment for migraine can be directed towards down regulating those receptor sites accordingly. Acthar may provide pain relief through this mechanist, as ACTH has been shown to inhibit the release of CGRP and may also provide relief through a negative feedback loop as exogenous ACTH inhibits CRH release and mast cell degranulation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Migraine
Keywords
Chronic Migraine, Headache, Refractory Chronic Migraine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
H.P. Acthar Gel 80IU
Arm Type
Experimental
Arm Description
H.P. Acthar Gel of 80IU (1.0 ml)
Arm Title
H.P. Acthar Gel 40IU
Arm Type
Experimental
Arm Description
H.P. Acthar Gel of 40IU (0.5 mL)
Intervention Type
Drug
Intervention Name(s)
H.P. Acthar Gel
Other Intervention Name(s)
Acthar, Repository Corticotropin Injection, ACTH Gel
Intervention Description
Acthar (40IU or 80IU) given subcutaneously for 5 days in the 1st week, followed by every other day (3 times per week for the next 3 weeks)
Primary Outcome Measure Information:
Title
Average total number of headache days (both 40IU and 80IU groups)
Description
Comparison of the average total number of headache days after 30 days of Acthar treatment (both 40IU and 80IU groups)with the average number of headache days at baseline screening period
Time Frame
After 30 days of treatment
Secondary Outcome Measure Information:
Title
Total number of headache days (both 40IU and 80IU groups)
Description
Comparison of the total number of headache days after 30 days of Acthar treatment (both 40IU and 80IU groups) with the number of headache days at baseline screening period
Time Frame
After 30 days of treatment
Other Pre-specified Outcome Measures:
Title
Number of headache and migraine days for a 40IU group
Description
A hierarchical analysis of the number of headache and (separately) migraine days subjects on 40IU experience on average during the 30 day treatment period compared to the number they experienced on average during the baseline screening period. If statistical significance (p<.05) is reached, then the 80IU subjects will be analyzed similarly
Time Frame
After 30 days of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is male or female, 18 to 60 years of age. Has a history of chronic migraine as classified by the International Headache Classification, ICHD-2R (i.e. must demonstrate an average of >=15 headache days per month, of which >=8 must be migraine days or >=8 days of migraine-specific acute medication-ergotamine or triptans for at least 3 months prior to study. Must demonstrate at least >=8 migraine days or >=8 days of migraine specific acute medications- ergotamine or triptans during 30 day baseline screening. Is able to differentiate migraine from any other headache they may experience (e.g., tension-type headache). Will have a previous history of failing at least one prophylactic treatment, which can include anti-seizure medications and/or TCA's prescribed for the treatment of chronic migraine. Must be considered a non-responder to previous treatment with Botox. Botox failure will be defined by previous documentation (at the discretion of the PI) or as having less than 30% reduction of headache days per month on Botox. Will have not had botulinum toxin with in 4 months before study enrollment. If female of childbearing potential, will have a negative urine pregnancy test at Visits 1 and 7, and uses, or agrees to use, for the duration of the study, a medically acceptable form of contraception as determined by the investigator. Complete abstinence from intercourse from 2 weeks prior to administration of study drug throughout the study, and for a time interval after completion or premature discontinuation from the study to account for elimination of the study drug (a minimum of 7 days); or, Surgically sterile (hysterectomy or tubal ligation or otherwise incapable of pregnancy); or, Sterilization of male partner; or, Intrauterine device with published data showing lowest expected failure rate is less than 1% per year; or, Double barrier method (i.e., 2 physical barriers OR 1 physical barrier plus spermicide) for a least 1 month prior to Visit 1 and throughout study; or, Hormonal contraceptives for at least 3 months prior to Visit 1 and throughout study. Protocol Number/v.1/06 Jun 2012 7 Must be in generally good health as confirmed by medical history, baseline physical exam, baseline neurological exam and vital signs. Exclusion Criteria: Is unable to understand the study requirements, the informed consent, or complete headache records as required per protocol. Is pregnant, actively trying to become pregnant, or breast-feeding. Has a significant systemic disease that is equally painful or more painful than migraine. Has a progressive neurological disorder such as MS. Has a history of chronic disease of the immune system other than MS or a known immunodeficiency syndrome such as HIV. Has sensitivity to proteins of porcine origin. Has a known or 'new' diagnosis of diabetes mellitus (if screening blood glucose is suspicious for diabetes [> or equal to 126 mg/dL or > or equal to 7 mmol/L if fasting;> or equal to 200 mg/dL or 11.1 mmol/L if random testing] a patient should be further evaluated for diabetes mellitus), or a known or 'new' diagnosis of hypothyroidism not adequately controlled with medication. Has previously taken Acthar for any reason. Has any contraindications listed on the Acthar PI. Has a history of cluster headache, chronic tension type headache, or headache due to medication over use according to IHS guidelines, in the 3 months prior to study enrollment or during the baseline phase. Has received any other investigative drug 30 days prior to enrollment in this study. Who in the opinion of the Principal Investigator has a condition for which they should not be enrolled in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Laszlo L Mechtler, M.D.
Organizational Affiliation
Dent Neurologic Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John F Rothrock, M.D.
Organizational Affiliation
Renown Institute for Neurosciences
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Roger K Cady, M.D.
Organizational Affiliation
Clinvest
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Frederick G Freitag, M.D.
Organizational Affiliation
Baylor Health Care System
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clinvest/A Division of Banyan Group, Inc.
City
Springfield
State/Province
Missouri
ZIP/Postal Code
65807
Country
United States
Facility Name
Renown Institute of Neurosciences
City
Reno
State/Province
Nevada
ZIP/Postal Code
89502
Country
United States
Facility Name
Dent Neurologic Institute
City
Amherst
State/Province
New York
ZIP/Postal Code
14226
Country
United States
Facility Name
Baylor University Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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A Two-Arm Study Evaluation H.P. Acthar Injection Gel in Treatment of Chronic Migraines

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