Efficacy and safety of DFN-15, an oral liquid formulation of celecoxib, in adults with migraine: a multicenter, randomized, placebo-controlled, double-blind, crossover study

Sagar Munjal, Alix Bennett, Sagar Munjal, Alix Bennett

Abstract

Background: The objective of this proof-of-concept study was to assess the safety, efficacy, and potential for dose response of a new oral liquid formulation of celecoxib, DFN-15, in adults with migraine. Variability in patient-identified most bothersome symptom (MBS) across 3 migraine attacks was also evaluated.

Methods: This was a randomized, placebo-controlled, double-blind, 3-treatment, 6-sequence, 3-period, crossover study of 3 treatments (DFN-15 120 mg, DFN-15 240 mg, and placebo) administered at the onset of moderate to severe headache.

Results: Of 63 randomized subjects, 56 (89%) took single doses of DFN-15 120 mg and 240 mg and completed all 3 treatment periods. Most subjects were female (75.0%) and white (86.7%), with a mean age of 43.6 years. Both doses of DFN-15 achieved a higher 2-hour pain-free response than placebo (29.1% for 120 mg, 26.1% for 240 mg, and 17.6% for placebo), but the differences were not statistically significant. Photophobia was most commonly reported as the MBS, but for 53% of subjects (27/51), their identified MBS varied across the 3 studied attacks. The most common treatment-emergent adverse events with DFN-15 were dysgeusia (≤11.8%) and nausea (≤5.9%).

Conclusion: Both doses of DFN-15 outperformed placebo for the 2-hour pain-free end point, but due to a carryover effect with placebo, the differences were not statistically significant. Since response to both doses was similar, DFN-15 120 mg is being further developed for the management of acute migraine. Further study is needed to determine whether the current findings are altered by larger or different trial designs (ClinicalTrials.gov identifier: NCT02472418).

Keywords: acute treatment; celecoxib; efficacy; episodic migraine; safety.

Conflict of interest statement

Disclosure SM and AB are employed by and own stock in Dr Reddy’s Laboratories. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Disposition of subjects.
Figure 2
Figure 2
Freedom from pain 2 hours after treatment with DFN-15 120 mg (overall and period 1).
Figure 3
Figure 3
Freedom from most bothersome symptom 2 hours after treatment with DFN-15 120 mg (period 1).

References

    1. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(6):754–762.
    1. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3–20.
    1. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA. 2000;284(10):1247–1255.
    1. Moore RA, Derry S, Makinson GT, McQuay HJ. Tolerability and adverse events in clinical trials of celecoxib in osteoarthritis and rheumatoid arthritis: systematic review and meta-analysis of information from company clinical trial reports. Arthritis Res Ther. 2005;7(3):R644–R665.
    1. Cryer B, Li C, Simon LS, Singh G, Stillman MJ, Berger MF. GI-REASONS: a novel 6-month, prospective, randomized, open-label, blinded endpoint (PROBE) trial. Am J Gastroenterol. 2013;108(3):392–400.
    1. Celebrex (celecoxib capsule) [prescribing information] New York: G.D. Searle LLC Division of Pfizer Inc; 2016. [Accessed September 21, 2017]. Available from: .
    1. Loo CY, Tan HJ, Teh HS, Raymond AA. Randomised, open label, controlled trial of celecoxib in the treatment of acute migraine. Singapore Med J. 2007;48(9):834–839.
    1. Pal A, Shenoy S, Gautam A, et al. Pharmacokinetics of DFN-15, a novel oral solution of celecoxib, versus celecoxib 400-mg capsules: a randomized crossover study in fasting healthy volunteers. Clin Drug Investig. 2017 Jul 26; Epub.
    1. Lipton RB, Hamelsky SW, Dayno JM. What do patients with migraine want from acute migraine treatment? Headache. 2002;42(Suppl 1):3–9.
    1. Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol. 2004;55(1):19–26.
    1. Headache Classification Subcommittee of the International Headache Society The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(Suppl 1):9–160.
    1. Saper J, Dahlof C, So Y, et al. Rofecoxib Protocol 162 Study Group Rofecoxib in the acute treatment of migraine: a randomized controlled clinical trial. Headache. 2006;46(2):264–275.
    1. Verrotti A, Parisi P, Agostinelli S, et al. Weight regain after discontinuation of topiramate treatment in patients with migraine: a prospective observational study. CNS Drugs. 2015;29(2):163–169.
    1. Viana M, Sances G, Ghiotto N, et al. Variability of the characteristics of a migraine attack within patients. Cephalalgia. 2016;36(9):825–830.
    1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia. 2013;33(9):629–808.
    1. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646–657.
    1. Lipton RB, Serrano D, Adams AM, Buse DC, Scher AI. EHMTI-0169. Trajectories of headache days over one year (5 waves) in chronic and episodic migraineurs participating in the chronic migraine epidemiology and outcomes (cameo) study. J Headache Pain. 2014;15(Suppl 1):D4.
    1. Food and Drug Administration Guidance for industry migraine: developing drugs for acute treatment. [Accessed September 21, 2017]. Available from: .
    1. Russell MB, Rasmussen BK, Brennum J, Iversen HK, Jensen RA, Olesen J. Presentation of a new instrument: the diagnostic headache diary. Cephalalgia. 1992;12(6):369–374.
    1. Johannes CB, Linet MS, Stewart WF, Celentano DD, Lipton RB, Szklo M. Relationship of headache to phase of the menstrual cycle among young women: a daily diary study. Neurology. 1995;45(6):1076–1082.
    1. Tfelt-Hansen P, Pascual J, Ramadan N, et al. International Headache Society Clinical Trials Subcommittee Guidelines for controlled trials of drugs in migraine: third edition. A guide for investigators. Cephalalgia. 2012;32(1):6–38.

Source: PubMed

3
Abonnere