A Multicenter Study to Evaluate the Efficacy of a 91-Day Extended Cycle Oral Contraceptive for Menstrually-Related Migraine Headaches

Experimental: 91-day Levonorgestrel Oral Contraceptive

Participants received 12 weeks (84 consecutive days) of active combination tablets containing 150 µg levonorgestrel (LNG)/30 µg ethinyl estradiol (EE), followed by 7 days of 10 µg EE monotherapy, for a total of 13 weeks.

Droga: Anticonceptivo oral de levonorgestrel de 91 días

Tratamiento de 91 días que consta de 84 comprimidos combinados azules que contienen 150 µg de LNG/30 µg de EE y 7 comprimidos amarillos que contienen 10 µg de EE.

Otros nombres:

• Estacional
• DR-105

Comparador de placebos: Placebo

Participants received placebo, 12 weeks (84 consecutive days) of inactive tablets, followed by an additional 7 days of inactive tablets, for a total of 13 weeks.

Droga: Placebo

1 tablet daily to match experimental arm

Percentage of Participants With ≥ 50% Reduction in Migraine Frequency During the Treatment Period

The number of participants with at least 50% reduction in migraine frequency (average weekly number of migraine episodes) through the end of the 91-day treatment period compared with Baseline (the 25- to 35-day baseline qualification period). Participants recorded the incidence, timing and intensity of migraines in a migraine diary during the prequalification period and throughout the 91-day treatment period.

Percentage of Participants With ≥ 50% Reduction in Migraine Frequency During the First, Second and Third Months

The percentage of participants with at least 50% reduction in migraine frequency (average weekly number of migraine episodes) compared to Baseline at each month of the treatment period.

Change From Baseline in Average Migraine Severity

Migraine severity was recorded by participants in the Baseline qualification diary and study migraine diary during the treatment period. Participants could report a severity of none (score = 0), mild (1), moderate (2), or severe (3). In general, if a headache was mild, daily activities could be resumed and little to no medication was taken. Moderate headaches required medication and effected daily activities. Severe headaches were debilitating and required medication.

Average migraine severity is defined as the sum of the severity ratings divided by the total number of migraine episodes reported during the observation period (for example, Baseline, First Month, Second Month, Third Month, and 91-Day Treatment Period). A negative change from Baseline score indicates improvement in severity.

Percentage of Participants Who Required Rescue Medications During the Study Period

Participants recorded use of rescue medications for migraines in the migraine diary during the course of study treatment.

Change From Baseline in Migraine Disability Assessment

The migraine disability assessment (MIDAS) test is used to determine how severely migraines affect a patient's life. Participants were asked five questions about how often their headaches limited their ability to go to work or school, to do household work or to do family or leisure activities in the past 3 months.

The MIDAS score equals the sum of the days answered for each question and ranges from 0 (no disability) to approximately 270 (severe disability; the upper bound is dependent on the number of days a participant would plan to work or participate in other activities).

The MIDAS score is classified into four grades of severity:

• 0 to 5: MIDAS Grade I, Little or no disability
• 6 to 10: MIDAS Grade II, Mild disability
• 11 to 20: MIDAS Grade III, Moderate disability
• 21+: MIDAS Grade IV, Severe disability

Change From Baseline in Headache Impact Test

The Headache Impact Test (HIT) is a tool used to measure the impact headaches have on patients' ability to function on the job, at school, at home and in social situations.

HIT-6 consists of 6 questions each scored on a scale from Never (6 points) to Always (13 points). The total score ranges from 36 to 78 with higher scores indicating greater impact on life.

There was an error in administration of the HIT-6 in this study. Question 6 was not administered, and question 3 from the MIDAS was included instead. Therefore, the total score of the HIT-6 could not be calculated.

Number of Participants With Adverse Events (AEs)

An AE is any untoward medical occurrence in a clinical investigation participant and which does not necessarily have to have a causal relationship with this treatment or clinical study.

The following definitions were used to assess AE severity: Mild: Awareness of signs or symptoms, but they are easily tolerated; Moderate: Enough discomfort to cause interference with usual activity; Severe: Incapacitating, with inability to perform usual activity.

Relationship to study drug was assessed as either: None: Causal relationship can be ruled out; Possibly: Causal relationship at least reasonably possible, i.e. relationship cannot be ruled out; Definitely: Causal relationship is certain.

A serious adverse event (SAE) is one that met any one of the following criteria:

• Fatal or life threatening
• Requires or prolongs in patient hospitalization
• Results in persistent or significant disability/incapacity
• Congenital anomaly / birth defect
• Important medical event.

Mean Number of Days of Bleeding or Spotting

Bleeding and spotting were recorded by participants in the migraine diary during the 91-day treatment period.