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A Randomized, Multicenter, Study for the prEvention and Acute Treatment of Migraine (REAL) (REAL)

Primary Purpose

Migraine

Status
Withdrawn
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
non-invasive vagus nerve stimulation
Sponsored by
ElectroCore INC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Migraine

Eligibility Criteria

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

Inclusion Criteria:

  • Is 18 years of age or above.
  • Has been previously diagnosed with episodic or chronic migraine (with or without aura) in accordance with the ICHD-3 Classification criteria.
  • Experience at least 6 and no more than 24 headache days per month and a minimum of 4 migraine attacks per month (over the last 3 months).
  • Has age of onset of migraine less than 50 years old.
  • Stable regime for any migraine preventative medications for the last 3 months and agrees to maintain stable regime for duration of the study.
  • Agrees to and in clinician opinion is able to use the nVNS device as intended, follow all of the requirements of the study including follow-up visit requirements, record required study data in the subject dairy, and other self-assessment questionnaires.
  • Availability of internet/Web access for Web-based e-diary completion
  • Is able to provide written Informed Consent.

Exclusion Criteria:

  • Requires use of oral or injectable steroids for concomitant medical condition that in the opinion of the investigator will interfere with the study.
  • Has a history of any intracranial aneurysm, intracranial haemorrhage, brain tumour or significant head trauma.
  • Has a structural abnormality at the nVNS treatment site (e.g. lymphadenopathy previous surgery or abnormal anatomy).
  • Has pain at the nVNS treatment site (e.g. dysesthesia, neuralgia and/or cervicalgia).
  • Has other significant pain problem (e.g. cancer pain or other head or facial disorder) that in the opinion of the investigator may confound the study assessments
  • Has known or suspected severe cardiac disease (e.g. symptomatic coronay artery disease, prior myocardial infarction, congestive heart failure (CHF)).
  • Has known or suspected severe cerebrovascular disease, (e.g. prior stroke or transient ischemic attack, symptomatic carotid artery disease, prior cartoid endarterectomy or other vascular neck surgery).
  • Has known or suspected own and/or family history of cardiac disease (including but not limited to ischemic heart disease, rhythm disturbances, congenital abnormalities cardiac myopathies), or presents risk factors strongly associated with risk for developing cardiologic abnormalities that in the opinion of the investigator might compromise subjects safety using n-VNS.
  • Has had a cervical vagotomy.
  • Has uncontrolled high blood pressure (systolic >160 diastolic > 100 after 3 repeated measurements within 24 hours).
  • Is currently implanted with an electrical and/or neurostimulator device (e.g. cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, cochlear implant, Spehnopalatine ganglion stimulator or Occiptial nerve stimulator).
  • Has been implanted with metal cervical spine hardware or has a metallic implant near the nVNS stimulation site (e.g. in the head, neck of thorax).
  • Presents a suspicion of secondary headache.
  • Previous diagnosis of medication overuse headache within the last 3 months
  • Has a history of syncope (within the last 1 year).
  • Has a history of seizures (within the last 1 year).
  • Has a known or suspicion of substance abuse or addiction (within the last 1 year).
  • Has initiated medications for migraine prophylaxis in the previous 30 days, or in the case of Botulinum toxin and monoclonal antibodies against CGRP injections in the previous 90 days.
  • Has failed an adequate trial (two months or greater) of at least 3 classes of a drug therapy for the prophylaxis of migraine.
  • Is pregnant or of childbearing years and is unwilling to use and accepted form of birth control (condom or contraceptive pill).
  • Is participating in any other therapeutic clinical investigation or has participated in a clinical trial in the preceding 30 days.
  • Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self- assessments is compromised (e.g. homeless, developmentally disabled and prisoner).
  • Has previously used the gammaCore device within the last 3 months.

Sites / Locations

  • Danish Headache Center
  • CTC, University Medical Center Hamburg-Eppendorf
  • Migräne- und Kopfschmerzklinik Königstein
  • Klinik für Neurologie, Ludwig-Maximilliams-Universität, Klinikum Grosshadern
  • Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
  • National Neurological Institute C. Mondino Foundatio
  • U.O. Neurologia III - Cefalee e Neuroalgologia, Fondazione IRCCS Istituto
  • Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele
  • University of Turin
  • Headache Unit, University Hospital Vall d'Hebron
  • Servicio de Neurologia, Hospital Ruber Internacional
  • Servicio de Neurologia, Clinica Universidad de Navarra
  • Servicio de Neurologia, Hospital Clinico Universitario de Valencia
  • Hull Royal Infirmary, Neurology Department
  • University of Birmingham
  • Queen Elizabeth Hospital Queen
  • Sunderland Royal Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

non-invasive Vagus Nerve Stimulation

Standard of Care

Arm Description

nVNS (non-invasive vagus nerve stimulation) treatment with the gammaCore Sapphire device and standard of care

Standard of Care treatment

Outcomes

Primary Outcome Measures

Reduction in number of migraine days during the last four weeks in the twelve-week randomized period compared with the four-week run-in period
Reduction in number of migraine days during the last four weeks in the twelve-week randomized period compared with the four-week run-in period

Secondary Outcome Measures

Reduction in number of headache days during the last four-weeks in the twelve-week randomized period compared to the four-week run-in period
Reduction in number of headache days during the last four-weeks in the twelve-week randomized period compared to the four-week run-in period
Reduction in number of migraine days and headache days (separately)
Reduction in number of migraine days and headache days (separately) during weeks 1 through 4, 5 through 8 in the 12 week randomised period
Rate of responders for the nVNS group compared to the standard of care group.
Rate of responders (mean reduction in migraine days during the last four weeks in the twelve-week randomization period compared to the four-week run-in period dichotomized as <25% vs. ≥25%, <50% vs ≥50% and <75% vs ≥75%, separately) for the nVNS group compared to the standard of care group.
Acute treatment response for nVNS and standard of care therapies
Acute treatment response for nVNS and standard of care therapies at 30, 60 and 120 minutes post-treatment, for all treated migraine attacks in the twelve-week randomized period
Consistency of response
Consistency of response as defined as the percentage of subjects who achieve treatment response in 25%, 50% and 75% or greater of their attacks, in subjects treating at least two attacks, for nVNS and standard of care therapies for all treated migraine attacks during the randomized period
Safety and tolerability of nVNS as measured by adverse events
Safety and tolerability of nVNS as measured by adverse events

Full Information

First Posted
December 20, 2018
Last Updated
June 12, 2019
Sponsor
ElectroCore INC
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1. Study Identification

Unique Protocol Identification Number
NCT03787238
Brief Title
A Randomized, Multicenter, Study for the prEvention and Acute Treatment of Migraine (REAL)
Acronym
REAL
Official Title
GM-18 - A Randomized, Multicenter, Study for the prEvention and Acute Treatment of Migraine Using Open Label Non-invasive Vagal Nerve Stimulation, Versus Standard of Care (REAL)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Withdrawn
Why Stopped
Company decision
Study Start Date
May 15, 2019 (Anticipated)
Primary Completion Date
September 1, 2020 (Anticipated)
Study Completion Date
October 1, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ElectroCore INC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a randomized study for the prevention and acute treatment of migraine using open label nVNS and standard of care versus standard of care. .
Detailed Description
A randomized study for the prevention and acute treatment of migraine using open label nVNS and standard of care versus standard of care. Eligible subjects will participate in a 4 week run-in period after which they will be randomized (1:1) to either nVNS and standard of care (nVNS group) or standard of care (SOC group) for 12 weeks. The nVNS group will use the nVNS device preventatively and acutely for the treatment of migraine. The SOC group will continue to use their regular standard of care migraine treatment medications for the duration of the 12 week randomized period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Migraine

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
non-invasive Vagus Nerve Stimulation
Arm Type
Experimental
Arm Description
nVNS (non-invasive vagus nerve stimulation) treatment with the gammaCore Sapphire device and standard of care
Arm Title
Standard of Care
Arm Type
No Intervention
Arm Description
Standard of Care treatment
Intervention Type
Device
Intervention Name(s)
non-invasive vagus nerve stimulation
Intervention Description
non-invasive vagus nerve stimulation using the gammaCore Sapphire device
Primary Outcome Measure Information:
Title
Reduction in number of migraine days during the last four weeks in the twelve-week randomized period compared with the four-week run-in period
Description
Reduction in number of migraine days during the last four weeks in the twelve-week randomized period compared with the four-week run-in period
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Secondary Outcome Measure Information:
Title
Reduction in number of headache days during the last four-weeks in the twelve-week randomized period compared to the four-week run-in period
Description
Reduction in number of headache days during the last four-weeks in the twelve-week randomized period compared to the four-week run-in period
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Title
Reduction in number of migraine days and headache days (separately)
Description
Reduction in number of migraine days and headache days (separately) during weeks 1 through 4, 5 through 8 in the 12 week randomised period
Time Frame
12 week randomised period
Title
Rate of responders for the nVNS group compared to the standard of care group.
Description
Rate of responders (mean reduction in migraine days during the last four weeks in the twelve-week randomization period compared to the four-week run-in period dichotomized as <25% vs. ≥25%, <50% vs ≥50% and <75% vs ≥75%, separately) for the nVNS group compared to the standard of care group.
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Title
Acute treatment response for nVNS and standard of care therapies
Description
Acute treatment response for nVNS and standard of care therapies at 30, 60 and 120 minutes post-treatment, for all treated migraine attacks in the twelve-week randomized period
Time Frame
12 week randomised period
Title
Consistency of response
Description
Consistency of response as defined as the percentage of subjects who achieve treatment response in 25%, 50% and 75% or greater of their attacks, in subjects treating at least two attacks, for nVNS and standard of care therapies for all treated migraine attacks during the randomized period
Time Frame
12 week randomised period
Title
Safety and tolerability of nVNS as measured by adverse events
Description
Safety and tolerability of nVNS as measured by adverse events
Time Frame
12 week randomised period
Other Pre-specified Outcome Measures:
Title
Change in acute headache medication use
Description
Change in acute headache medication use (proportion of attacks with acute medication use prior to or at 120 minutes post-treatment) for all treated attacks in the twelve-week randomized period compared to the four week run-in period in the nVNS group
Time Frame
12 week randomization period compared to the four week run-in period
Title
Presence or absence of nausea, vomiting, photophobia, phonophobia
Description
Presence or absence of nausea, vomiting, photophobia, phonophobia at 0, 30, 60 and 120 minutes post treatment for nVNS and standard of care therapies for all treated migraine attacks in the randomized period
Time Frame
12 week randomised period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is 18 years of age or above. Has been previously diagnosed with episodic or chronic migraine (with or without aura) in accordance with the ICHD-3 Classification criteria. Experience at least 6 and no more than 24 headache days per month and a minimum of 4 migraine attacks per month (over the last 3 months). Has age of onset of migraine less than 50 years old. Stable regime for any migraine preventative medications for the last 3 months and agrees to maintain stable regime for duration of the study. Agrees to and in clinician opinion is able to use the nVNS device as intended, follow all of the requirements of the study including follow-up visit requirements, record required study data in the subject dairy, and other self-assessment questionnaires. Availability of internet/Web access for Web-based e-diary completion Is able to provide written Informed Consent. Exclusion Criteria: Requires use of oral or injectable steroids for concomitant medical condition that in the opinion of the investigator will interfere with the study. Has a history of any intracranial aneurysm, intracranial haemorrhage, brain tumour or significant head trauma. Has a structural abnormality at the nVNS treatment site (e.g. lymphadenopathy previous surgery or abnormal anatomy). Has pain at the nVNS treatment site (e.g. dysesthesia, neuralgia and/or cervicalgia). Has other significant pain problem (e.g. cancer pain or other head or facial disorder) that in the opinion of the investigator may confound the study assessments Has known or suspected severe cardiac disease (e.g. symptomatic coronay artery disease, prior myocardial infarction, congestive heart failure (CHF)). Has known or suspected severe cerebrovascular disease, (e.g. prior stroke or transient ischemic attack, symptomatic carotid artery disease, prior cartoid endarterectomy or other vascular neck surgery). Has known or suspected own and/or family history of cardiac disease (including but not limited to ischemic heart disease, rhythm disturbances, congenital abnormalities cardiac myopathies), or presents risk factors strongly associated with risk for developing cardiologic abnormalities that in the opinion of the investigator might compromise subjects safety using n-VNS. Has had a cervical vagotomy. Has uncontrolled high blood pressure (systolic >160 diastolic > 100 after 3 repeated measurements within 24 hours). Is currently implanted with an electrical and/or neurostimulator device (e.g. cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, cochlear implant, Spehnopalatine ganglion stimulator or Occiptial nerve stimulator). Has been implanted with metal cervical spine hardware or has a metallic implant near the nVNS stimulation site (e.g. in the head, neck of thorax). Presents a suspicion of secondary headache. Previous diagnosis of medication overuse headache within the last 3 months Has a history of syncope (within the last 1 year). Has a history of seizures (within the last 1 year). Has a known or suspicion of substance abuse or addiction (within the last 1 year). Has initiated medications for migraine prophylaxis in the previous 30 days, or in the case of Botulinum toxin and monoclonal antibodies against CGRP injections in the previous 90 days. Has failed an adequate trial (two months or greater) of at least 3 classes of a drug therapy for the prophylaxis of migraine. Is pregnant or of childbearing years and is unwilling to use and accepted form of birth control (condom or contraceptive pill). Is participating in any other therapeutic clinical investigation or has participated in a clinical trial in the preceding 30 days. Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self- assessments is compromised (e.g. homeless, developmentally disabled and prisoner). Has previously used the gammaCore device within the last 3 months.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexandra Sinclair, MD
Organizational Affiliation
University of Birmingham
Official's Role
Principal Investigator
Facility Information:
Facility Name
Danish Headache Center
City
Glostrup
ZIP/Postal Code
DK-2600
Country
Denmark
Facility Name
CTC, University Medical Center Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
D-20251
Country
Germany
Facility Name
Migräne- und Kopfschmerzklinik Königstein
City
Königstein im Taunus
ZIP/Postal Code
D-61462
Country
Germany
Facility Name
Klinik für Neurologie, Ludwig-Maximilliams-Universität, Klinikum Grosshadern
City
München
ZIP/Postal Code
D-81377
Country
Germany
Facility Name
Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
City
Rostock
ZIP/Postal Code
D-18147
Country
Germany
Facility Name
National Neurological Institute C. Mondino Foundatio
City
Mondino
State/Province
Pavia
ZIP/Postal Code
27100
Country
Italy
Facility Name
U.O. Neurologia III - Cefalee e Neuroalgologia, Fondazione IRCCS Istituto
City
Milan
ZIP/Postal Code
20133
Country
Italy
Facility Name
Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele
City
Rome
ZIP/Postal Code
00163
Country
Italy
Facility Name
University of Turin
City
Turin
ZIP/Postal Code
10124
Country
Italy
Facility Name
Headache Unit, University Hospital Vall d'Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Servicio de Neurologia, Hospital Ruber Internacional
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Servicio de Neurologia, Clinica Universidad de Navarra
City
Pamplona
ZIP/Postal Code
ES-31008
Country
Spain
Facility Name
Servicio de Neurologia, Hospital Clinico Universitario de Valencia
City
Valencia
ZIP/Postal Code
ES-46010
Country
Spain
Facility Name
Hull Royal Infirmary, Neurology Department
City
Hull
State/Province
East Yorkshire
ZIP/Postal Code
HU3 2JZ
Country
United Kingdom
Facility Name
University of Birmingham
City
Birmingham
ZIP/Postal Code
B15 2TT
Country
United Kingdom
Facility Name
Queen Elizabeth Hospital Queen
City
Gateshead
ZIP/Postal Code
NE9 6SX
Country
United Kingdom
Facility Name
Sunderland Royal Hospital
City
Sunderland
ZIP/Postal Code
SR4 7TP
Country
United Kingdom

12. IPD Sharing Statement

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A Randomized, Multicenter, Study for the prEvention and Acute Treatment of Migraine (REAL)

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