Subcutaneous delivery of sumatriptan in the treatment of migraine and primary headache

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy, Tolerability, and Safety of Celecoxib Oral Solution (ELYXYB) in Acute Treatment of Episodic Migraine with or without Aura

Background

Safe, effective, oral therapies are needed for acute treatment of migraine. This clinical trial assessed the efficacy, tolerability, and safety of celecoxib oral solution (ELYXYB) in a single migraine attack associated with moderate-to-severe pain.

Methods

This was a phase III, randomized (1:1), double-blind, placebo-controlled trial, conducted at 41 US centers from December 2016 to October 2017. Adults with episodic migraine (with or without aura) for ≥1 year were treated with a single 4.8 mL dose of 120-mg celecoxib oral solution or placebo. Co-primary endpoints were the proportion of patients who were pain-free and free from the most bothersome migraine symptom (MBS) at 2 hours post-dose. The MBS was identified at screening from among nausea, photophobia, or phonophobia.

Results

Six hundred thirty-one patients were randomized (celecoxib oral solution, n=316; placebo, n=315; mean age 41 years, range 18-75; 84.3% female). One study site met prespecified outlier criteria (defined as a treatment effect estimate that was at least twice as large as all other sites) and was excluded from efficacy analyses. This site had a mean 2-hour pain freedom placebo response rate of 75% vs a combined mean of 23.5% for all other sites. In subsequent analysis, 2-hour post-dose pain freedom response rates were significantly higher in the celecoxib oral solution group vs placebo (32.8%, [27.2%, 38.8%]) vs 23.5%, [18.5%, 29.2%]; P=0.020). For 2-hour post-dose MBS freedom, response rates were significantly higher in the celecoxib oral solution group vs placebo (58.1% [51.4%, 64.5%] vs 43.9% [37.2%, 50.7%]; P=0.003). A total of 10.7% (31/289) of patients treated with celecoxib oral solution and 9.9% (28/283) of placebo-treated patients reported a treatment-emergent adverse event (TEAE). Study drug-related TEAEs were reported by 7.3% (21/289) and 7.4% (21/283) of celecoxib oral solution and placebo patients, respectively; the most common were nausea (celecoxib oral solution: 1.4% [4/289] vs placebo: 1.8% [5/283]) and dysgeusia (celecoxib oral solution: 1.7% [5/289] vs placebo: 1.1% [3/283]). No serious TEAEs, deaths, or drug-related TEAEs leading to withdrawal were reported.

Conclusion

Celecoxib oral solution is a safe, effective COX-2-selective nonsteroidal anti-inflammatory drug for the treatment of acute migraine. In this analysis, celecoxib oral solution was significantly more effective than placebo and was also associated with a low rate of gastric TEAEs. Celecoxib oral solution may provide a convenient, alternate option to currently available treatments.

Trial Registration

ClinicalTrials.gov Identifier: NCT03009019; registered January 4, 2017; retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03009019.

Transjecting growth hormone: continuous nightmare or controlled nuisance? Evaluation of a new needle-free device

BACKGROUND

Administering growth-hormone therapy (GHT) is a long-term treatment, associated with avoidance and phobic behaviors in the children involved. The current study examined GHT users' perceptions of a new needle-free device (ZomaJet Vision X [10 mg/mL]) with a lower injection volume compared to the traditional device.

METHODS

A total of 73 persons participated (mean age ± standard deviation, 10.10 ± 3.60 years) in a longitudinal design. Users' views were studied 4 weeks after having applied both the old and the new device for a period of at least 4 weeks. Satisfaction, ease and frequency of restitution, local sensations, bruises during administering GHT, affective response to local sensations, and subject preference were assessed on the basis of the users' responses.

RESULTS

Subjects' satisfaction with the new device was equal compared with the previous device for the total group of 73 children. However, the subgroup of 59 children who proved tolerant to meta-cresol (new preservative for Vision X only) reported a significantly higher satisfaction rating with the new device compared to the old device (7.7 vs 6.6, P=0.0002). Vision X was evaluated as better on ease and frequency of restitution and the number of bruises. Pain sensations did not differ meaningfully between the two devices. The new device was favored over the previous one in a majority of respondents. Vision X allows easy reconstitution of the solution, which was reflected in the percentage of young children able to prepare transjections themselves being more than doubled, illustrating the greater sense of empowerment in these users. Self-reported adherence to the therapy was good (less than 10% of injections missed) with both devices.

CONCLUSION

The new device ZomaJet Vision X appears to be evaluated more positively than the previous version on criteria that refect users' preferences.