IM Ketorolac vs Cambia for the Acute Treatment of Severe Migraine

NCT ID: NCT02664116

Last Updated: 2016-02-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2017-07-31

Brief Summary

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This research will be conducted to see if the oral drug Cambia is as effective in relieving severe migraine headaches as the injectable drug ketorolac.

Detailed Description

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The treatment of severe migraine often requires a patient office visit or treatment in the ER or urgent care setting. This is due to the minimal efficacy of PO treatments once migraine is severe, and therefore the need for parenteral treatments. IM Ketorolac is one mainstay of parenteral treatment. There is an unmet need for effective at-home treatment regimens for severe migraine. Despite FDA approval of Cambia for acute migraine treatment, insurance is reticent to cover the treatment due to higher cost in comparison to generic diclofenac tablets, despite superior efficacy of Cambia in comparison to generic diclofenac tablets (Diener, Cephalalgia 2006). One objective of this study would be to provide rationale to justify the insurance coverage of this treatment in comparison to generic tablets, because at home treatment is less costly than office visit or emergency department visit to receive IM ketorolac.

A previous study of Cambia demonstrated that this formulation of diclofenac potassium for oral solution is effective in reducing pain intensity within 30 minutes, which may be related to the 15-minute Tmax associated with this formulation. The rapid-onset benefits were sustained through 24 hours post-treatment (Lipton, Cephalalgia 2010)

Conditions

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Migraine Headache

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Cambia

Diclofenac postassium powder for oral solution and placebo injection

Group Type EXPERIMENTAL

Diclofenac postassium powder for oral solution and placebo injection

Intervention Type DRUG

Diclofenac postassium powder for oral solution 50 mg in 1 ounce water orally, single dose and placebo normal saline 2ml intramuscular injection, single dose

ketorolac

ketorolac intramuscular injection and placebo oral solution

Group Type ACTIVE_COMPARATOR

Ketorolac intramuscular injection and placebo oral solution

Intervention Type DRUG

ketorolac 60 mg in 2 ml intramuscular injection, single dose and placebo oral solution, 1 ounce, single dose

Interventions

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Diclofenac postassium powder for oral solution and placebo injection

Diclofenac postassium powder for oral solution 50 mg in 1 ounce water orally, single dose and placebo normal saline 2ml intramuscular injection, single dose

Intervention Type DRUG

Ketorolac intramuscular injection and placebo oral solution

ketorolac 60 mg in 2 ml intramuscular injection, single dose and placebo oral solution, 1 ounce, single dose

Intervention Type DRUG

Other Intervention Names

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Cambia Toradol

Eligibility Criteria

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Inclusion Criteria

* Patients who meet IHS criteria for migraine
* Age 18 to 65
* At least 2 migraine attacks per month
* Able to give written consent
* Willing to complete the entire course of the study
* Current headache duration greater than or equal to 36 hours

Exclusion Criteria

* Pregnant or nursing
* Significant medical or psychiatric disease
* History of gastritis, gastric ulcer, GI bleed
* Renal insufficiency
* Hepatic insufficiency
* History of opioid dependence within the last 10 years or currently
* Any current or prior use of DICLOFENAC POTASSIUM POWDER FOR ORAL SOLUTION (CAMBIA)
* Past allergic reaction to DICLOFENAC or other NSAIDs
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Depomed

INDUSTRY

Sponsor Role collaborator

Scripps Health

OTHER

Sponsor Role lead

Responsible Party

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Emily Rubenstein Engel

Associate Director, Dalessio Headache Center, Scripps Clinic

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Emily Rubenstein Engel, MD

Role: PRINCIPAL_INVESTIGATOR

Scripps Health

Locations

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Scripps Clinic

La Jolla, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Emily Rubenstein Engel, MD

Role: CONTACT

858-554-8887

Facility Contacts

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Emily Rubenstein Engel, M.D.

Role: primary

858-554-8887

References

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Factor SA, Jankovic J. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology. 2014 Oct 7;83(15):1388-9. doi: 10.1212/01.wnl.0000455698.16732.0a. No abstract available.

Reference Type BACKGROUND
PMID: 25288700 (View on PubMed)

Garnock-Jones KP. Diclofenac potassium powder for oral solution: a review of its use in patients with acute migraine. CNS Drugs. 2014 Aug;28(8):761-8. doi: 10.1007/s40263-014-0186-y.

Reference Type BACKGROUND
PMID: 25034250 (View on PubMed)

Friedman BW, Garber L, Yoon A, Solorzano C, Wollowitz A, Esses D, Bijur PE, Gallagher EJ. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology. 2014 Mar 18;82(11):976-83. doi: 10.1212/WNL.0000000000000223. Epub 2014 Feb 12.

Reference Type BACKGROUND
PMID: 24523483 (View on PubMed)

Taggart E, Doran S, Kokotillo A, Campbell S, Villa-Roel C, Rowe BH. Ketorolac in the treatment of acute migraine: a systematic review. Headache. 2013 Feb;53(2):277-87. doi: 10.1111/head.12009. Epub 2013 Jan 8.

Reference Type BACKGROUND
PMID: 23298250 (View on PubMed)

Lipton RB, Grosberg B, Singer RP, Pearlman SH, Sorrentino JV, Quiring JN, Saper JR. Efficacy and tolerability of a new powdered formulation of diclofenac potassium for oral solution for the acute treatment of migraine: results from the International Migraine Pain Assessment Clinical Trial (IMPACT). Cephalalgia. 2010 Nov;30(11):1336-45. doi: 10.1177/0333102410367523. Epub 2010 Apr 7.

Reference Type BACKGROUND
PMID: 20959428 (View on PubMed)

Duarte C, Dunaway F, Turner L, Aldag J, Frederick R. Ketorolac versus meperidine and hydroxyzine in the treatment of acute migraine headache: a randomized, prospective, double-blind trial. Ann Emerg Med. 1992 Sep;21(9):1116-21. doi: 10.1016/s0196-0644(05)80654-7.

Reference Type BACKGROUND
PMID: 1514724 (View on PubMed)

Orr SL, Aube M, Becker WJ, Davenport WJ, Dilli E, Dodick D, Giammarco R, Gladstone J, Leroux E, Pim H, Dickinson G, Christie SN. Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings. Cephalalgia. 2015 Mar;35(3):271-84. doi: 10.1177/0333102414535997. Epub 2014 May 29.

Reference Type BACKGROUND
PMID: 24875925 (View on PubMed)

Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache. 2015 Jan;55(1):3-20. doi: 10.1111/head.12499.

Reference Type BACKGROUND
PMID: 25600718 (View on PubMed)

Diener HC, Montagna P, Gacs G, Lyczak P, Schumann G, Zoller B, Mulder LJ, Siegel J, Edson K. Efficacy and tolerability of diclofenac potassium sachets in migraine: a randomized, double-blind, cross-over study in comparison with diclofenac potassium tablets and placebo. Cephalalgia. 2006 May;26(5):537-47. doi: 10.1111/j.1468-2982.2005.01064.x.

Reference Type BACKGROUND
PMID: 16674762 (View on PubMed)

Engel ER, Cheng J. IM ketorolac vs diclofenac potassium powder for oral solution for the acute treatment of severe migraine: a randomized controlled trial. Neurol Sci. 2020 Mar;41(3):537-542. doi: 10.1007/s10072-019-04157-y. Epub 2019 Dec 12.

Reference Type DERIVED
PMID: 31833000 (View on PubMed)

Other Identifiers

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DHC-002

Identifier Type: -

Identifier Source: org_study_id

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