Efficacy of Erenumab on Functional Impact of Migraine

Study Overview
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Brief Summary
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The purpose of this study is to assess the efficacy of erenumab on functional impact due to Migraine in adults.

Detailed Description
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This is a single group, multicenter, open-label study with a study population of patients who meet International Classification of Headache Disorders 3rd edition (ICHD-III) criteria for migraine with or without aura and have 4 to 20 migraine days per month. This is a single-group supportive care study with one arm and no masking. A maximum of 54 participants will be enrolled to study intervention. All participants in this single-group study will complete a 4-week run-in period. After the run-in period, eligible participants will be enrolled to study intervention and enter a 12-week treatment period.

Official Title
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A Multicenter, Open Label Study Assessing the Efficacy of Erenumab on Functional Impact of Migraine

Conditions
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Migraine

Intervention / Treatment
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* Drug: Erenumab-Aooe 140 MG/ML [Aimovig]


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants are eligible to be included in the study only if all of the following criteria apply: willing to participate and sign informed consent; ability to understand informed consent and study procedures, including able to use the electronic Daily Headache Diary; in good general health based on investigator's judgment; must be between 18 to 65 years of age, inclusive, at time of Visit 2; have migraine with or without aura meeting the diagnostic criteria listed in the International Classification of Headache Disorders 3rd edition (ICHD-III; Appendix 5); verification of headache frequency through prospectively collected baseline information during the 28-day screening/baseline phase reporting 4-20 migraine days and no more than 20 total headache days; onset of migraine before age 50; able to differentiate migraine from other primary headache types allowed in the study (e.g., tension-type headache); stable history of migraine at least 3 months prior to screening with headache free periods; not currently taking a migraine preventive OR has been taking a stable dose of a preventive for at least 90 days prior to screening and agrees to not start, stop, or change medication and/or dosage during the study period; **participants on migraine preventive should have stable headache pattern must have a score of ≥ 3 on the Migraine Functional Impact Questionnaire (MFIQ) overall impact on usual activities item at screening; women may be included only if they have a negative pregnancy test at screening and baseline, are sterile, or postmenopausal. Women of childbearing potential (WOCBP) whose male partners are potentially fertile (i.e., no vasectomy) must use highly effective birth control methods for the duration of the study (i.e., starting at screening). Definitions of WOCBP, sterile and postmenopausal women, male contraception, and highly effective and acceptable birth control methods are to be determined based on investigator's judgment; demonstrated compliance with the electronic Daily Headache Diary during the 28-day screening/baseline phase as defined by entry of headache data on a minimum of 23 days; is willing to wear activity/sleep tracker throughout the duration of the trial; has a smartphone and willing to install activity tracker app on phone. Exclusion Criteria: Participants are excluded from the study if any of the following criteria apply: unable to understand the study requirements, the informed consent, or complete headache records as required per protocol; pregnant, actively trying to become pregnant, or breast-feeding; history of substance abuse and/or dependence, in the opinion of the Investigator; history of impaired renal function that, in the investigator's opinion, contraindicates participation in this study; suffers from a serious illness, or an unstable medical condition, one that could require hospitalization, or could increase the risk of adverse events; a psychiatric condition, in the opinion of the investigator, that may affect the interpretation of efficacy and safety data or contraindicates the participant's participation in the study; received nerve blocks or trigger point injections in the previous 8 weeks or plans to receive them during the study; prior exposure in the last 6 months to biologics or drugs specifically targeting the calcitonin gene-related peptide (CGRP) pathway; has failed more than 3 classes of medications for the prevention of migraine, or >6 migraine preventative medications of any type due to lack of efficacy; received any investigational agents within 30 days prior to Visit 1 (6 months for any investigational biological products unless previous study blind has been broken and subject was known to have received placebo); plans to participate in another clinical study at any time during this study; history of medication overuse of opioids or butalbital, as defined by opioid or butalbital use ≥10 days/month in previous 12 months or during run-in period; Medication Overuse Headache (MOH) with other medication types will be allowed but must be documented; unstable medication use for migraine prevention (changes in the last 3 months); clinically relevant lab results at screening as determine by the investigator; clinically relevant or significant ECG abnormalities as determine by the investigator, including ECG with QT interval corrected for heart rate (QTc) using Fridericia's correction formula (QTcF) > 500 msec; history of any of the following cardiovascular conditions: Moderate to severe congestive heart failure (New York Heart Association class III or IV); Recent (within past 12 months) cerebrovascular accident, myocardial infarction, coronary stenting; Uncontrolled hypertension as defined by a confirmed systolic blood pressure > 160 mmHg or diastolic blood pressure > 100 mmHg. active HIV or Hepatitis C infection; allergy to latex; score of > 0 on question 9 on Patient Health Questionnaire (PHQ-9) at any visit; have any other condition, that in the judgment of the investigator, would make the participant unsuitable for inclusion, or would interfere with the participant participating in or completing the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Erenumab-Aooe 140 MG/ML [Aimovig]<br>Participants received 140 mg/mL administered subcutaneously once every 4 weeks in the abdomen, thigh, or upper arm for three months (12 weeks). | Drug: Erenumab-Aooe 140 MG/ML [Aimovig]<br>* 140 mg/mL administered subcutaneously<br>* Other names: Aimovig;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Migraine Functional Impact Questionnaire (MFIQ) - Overall Impact on Usual Activities Scores at Baseline and at End of Treatment (Treatment Month 3). | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the single MFIQ Global Item Overall Impact on Usual Activities (item # 16). The item's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Month 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Physical Function Domain Scores at Baseline and at the End of Treatment (Treatment Month 3). | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Physical Function. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Month 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Usual Activities Scores at Baseline and at the End of Treatment (Treatment Month 3). | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Usual Activities. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Month 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Emotional Function Scores at Baseline and at the End of Treatment (Treatment Month 3). | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Emotional Function. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Month 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Social Function Scores at Baseline and at the End of Treatment (Treatment Month 3). | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Social Function. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Month 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Overall Impact on Usual Activities Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the single MFIQ Global Item Overall Impact on Usual Activities (item # 16). The item's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Months 1, 2, and 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Physical Function Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Physical Function The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Months 1, 2, and 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Usual Activities Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Usual Activities. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Months 1, 2, and 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Emotional Function Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Emotional Function. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Months 1, 2, and 3 | 
| Migraine Functional Impact Questionnaire (MFIQ) - Impact on Social Function Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Functional Impact Questionnaire (MFIQ) is a 26-item self-report questionnaire. It is designed to measure the impact of migraine on physical, social, and emotional functioning over 5 domains: Physical Function (PF), Usual Activities (UA), Overall impact on Usual Activities, Social Function (SF), and Emotional Function (EF). Final transformed scores range from 0-100, with higher scores indicating more impact on the participant. For this endpoint we will be measuring changes in participant's response on the MFIQ domain, Social Function. The domain's transformed score can range from 0-100, with higher scores indicating more impact on the participant. | Baseline and Treatment Months 1, 2, and 3 | 
| Migraine Interictal Burden Scale (MIBS-4) Scores at Baseline and at Treatment Months 1, 2, and 3. | The Migraine Interictal Burden Scale (MIBS-4) is a 4-item, self-administered questionnaire which measures interictal migraine-related burden in 4 domains: impairment in work or school, impairment in family and social life, difficulty making plans or commitments, and emotional/affective and cognitive distress. Possible scores range from 0 (No interictal burden) to 12 (Severe interictal burden). Higher scores indicate worse interictal burden. | Baseline and Treatment Months 1, 2, and 3 | 
| Number of Migraine Days at Baseline and at Treatment Months 1, 2, and 3. | Comparison of the mean change from baseline in the frequency of migraine headache days per 28-day period ending with the cessation of treatment month 3. A migraine headache day will be defined as a calendar day (00:00 to 23:59) with 4 or more hours of migraine headache, fulfilling International Classification of Headache Disorders-3 criteria, and/or any headache of any duration with the use of migraine-specific acute medications(s) (i.e. ergot alkaloids, ergot combinations, opioids, triptans, combination analgesics [simple analgesics combined with opioids or barbiturate with or without caffeine]). | Baseline and Treatment Months 1, 2, and 3 | 
| Work Productivity and Activity Impairment- Migraine (WPAI-M): Absenteeism Domain Scores at Baseline and at Treatment Months 1, 2, and 3. | The Work Productivity and Activity Impairment- Migraine (WPAI-M) is a 6-item self-administered questionnaire that measures work productivity and the amount of time missed from work due to migraine. Domain scores are expressed as a percentage, with a range of scores form 0-100%, with higher scores indicating greater impairment and less productivity. | Baseline and Treatment Months 1, 2, and 3 | 
| Work Productivity and Activity Impairment- Migraine (WPAI-M): Activity Impairment Domain Scores at Baseline and at Treatment Months 1, 2, and 3. | The Work Productivity and Activity Impairment- Migraine (WPAI-M) is a 6-item self-administered questionnaire that measures work productivity and the amount of time missed from work due to migraine. Domain scores are expressed as a percentage, with a range of scores form 0-100%, with higher scores indicating greater impairment and less productivity. | Baseline and Treatment Months 1, 2, and 3 | 
| Work Productivity and Activity Impairment- Migraine (WPAI-M): Work Productivity Loss Domain Scores at Baseline and at Treatment Months 1, 2, and 3. | The Work Productivity and Activity Impairment- Migraine (WPAI-M) is a 6-item self-administered questionnaire that measures work productivity and the amount of time missed from work due to migraine. Domain scores are expressed as a percentage, with a range of scores form 0-100%, with higher scores indicating greater impairment and less productivity. | Baseline and Treatment Months 1, 2, and 3 | 
| Work Productivity and Activity Impairment- Migraine (WPAI-M): Presenteeism Domain Scores at Baseline and at Treatment Months 1, 2, and 3. | The Work Productivity and Activity Impairment- Migraine (WPAI-M) is a 6-item self-administered questionnaire that measures work productivity and the amount of time missed from work due to migraine. Domain scores are expressed as a percentage, with a range of scores form 0-100%, with higher scores indicating greater impairment and less productivity. | Baseline and Treatment Months 1, 2, and 3 | 
| Neuro-QoL Sleep Disturbance Short Form (SDSF) Scores at Baseline and at Treatment Months 1, 2, and 3. | The Neuro-QoL Sleep Disturbance Short Form (SDSF) is an 8-item, self-administered questionnaire which measures quality of sleep including difficulties and perception of sleep satisfaction. Possible transformed t-scores ranging from 32 to 84.20, with higher scores indicating worse sleep habits. | Baseline and Treatment Months 1, 2, and 3 | 
| General Self-Efficacy Severity Scale (GSESS) Scores at Baseline and at Treatment Months 1, 2, and 3. | The General Self-Efficacy Severity Scale (GSESS) is a 4 item, self-administered questionnaire where the participant is asked to rate their confidence in managing situations, problems, and events. Final scores range from 18.60 to 64.70 and are represented by the T-score, a standardized score with a mean of 50 and a standard deviation (SD) of 10. Higher scores indicate the participant has more self-efficacy managing difficult situations. | Baseline and Treatment Months 1, 2, and 3 | 
| Brief Measure of Worry Severity (BMWS) Scores at Baseline and at Treatment Months 1, 2, and 3 | The Brief Measure of Worry Severity (BMWS) is a 8-item, self-administered questionnaire that measures various components of dysfunctional worry. Score range from 0-24 with higher scores indicating more worry within the participant. | Baseline and Treatment Months 1, 2, and 3 |