Primary objective: To investigate the efficacy and tolerability of two doses of tonabersat compared to placebo in the prophylaxis of migraine headache and to evaluate the longer term tolerability of tonabersat in an open label extension. Secondary objective(s): To obtain further data on the efficacy and dose response of tonabersat; To extend the safety and tolerability database of tonabersat; To obtain data on the pharmacokinetics of tonabersat.
A multi-centre, double-blind, placebo controlled, randomized, parallel group, dose ranging study to investigate the efficacy and tolerability of two different target doses of tonabersat and placebo in the prophylaxis of migraine. Following initial screening patients will enter a 4 week baseline assessment period, prior to randomization to one of three treatment groups. Subsequently patients will be allocated, according to the predetermined randomization schedule, to treatment with placebo or a target dose of tonabersat 40 mg/day or 80 mg/day in a 20 week treatment period. A dose titration regimen will be employed over a period of 4 weeks and treatment will then be maintained for a further 16 weeks. During the baseline assessment period and the treatment period patients will maintain a daily record (diary data) of the occurrence of migraine headache, the severity of an attack, the presence/absence of a preceding aura, other symptoms associated with the migraine and details of the use of rescue medication (patients will be permitted to use their usual symptomatic/acute treatment as rescue medication throughout the trial). Patients will attend the clinic for assessment and collection of blood and urine samples for laboratory analysis, and a sub-population of patients will participate in a pharmacokinetic study. A total of 7 visits are planned during the randomized double-blind treatment period. On completion of the randomized double-blind treatment period all patients will be offered the opportunity to enter an open label extension study where all patients receive tonabersat. A dose titration regimen will be employed over a period of 1 month and the final assigned dose of tonabersat (40, 60 or 80 mg/day) will be continued for the next 12 months. During the open label extension patients will attend the clinic for regular assessment of migraine status and safety. A total of 5 visits are planned.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Tablets, 4 week dose titration and 16 weeks treatment at target dose of 40 mg per day
Tablets: 4 week titration and 16 weeks at target dose of 80 mg per day
Tablets; 4 week dose titration with 16 weeks at target dose
Reduction in the mean monthly number of migraine attacks over the last 2 months of the treatment period.
Time frame: 4 weeks baseline and 20 weeks DB treatment
Safety and tolerability: incidence of all AEs, serious adverse events (SAEs) and those leading to withdrawal of study medication, review of laboratory data, including hematology, biochemistry, and urinalysis, physical examinations, and vital signs.
Time frame: 4 weeks baseline, 20 weeks DB treatment and 13 months open label extension
Assessment of population pharmacokinetics for tonabersat - blood samples will be collected from a sub-population of patients
Time frame: 20 weeks DB treatment
• Reduction in mean monthly migraine attacks during the last 4 months of the treatment period and during each month of the treatment period.
Time frame: 4 weeks baseline and 20 weeks DB treatment
• Proportion of patients defined as a responder i.e. difference between treatment groups in the number of patients with a reduction of at least 50% in the mean monthly frequency of migraine attacks during defined periods.
Time frame: 4 week baseline and 20 weeks DB treatment
• Reduction in mean monthly migraine headache days i.e. the difference between the two treatment groups in the reduction from baseline during defined periods
Time frame: 4 weeks baseline and 20 weeks DB treatment
• Proportion of patients defined as a responder i.e. difference between treatment groups in the number of patients with a reduction of at least 50% in the mean monthly number of migraine headache days during defined periods
Time frame: 4 weeks baseline and 20 weeks DB treatment
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Purpose
PREVENTION
Masking
TRIPLE
Enrollment
542
• Reduction in mean monthly consumption (number of days per month) of rescue medication during defined periods
Time frame: 4 weeks baseline and 20 weeks DB treatment
• Onset of action (defined as first monthly period for which a significant difference between treatment groups is observed and is then maintained over the rest of the treatment period).
Time frame: 4 weeks baseline and 20 weeks DB treatment
• Difference between treatment groups in the maximum severity of migraine attacks occurring during defined periods
Time frame: 4 weeks baseline and 20 weeks DB treatment
• Summary of the Migraine Disability Assessment Score (MIDAS) assessments.
Time frame: 4 weeks baseline, 20 weeks DB treatment and 13 months open label extension