A Multi-Center Double-Blind Pilot Comparison of OnabotulinumtoxinA and Topiramate for the Prophylactic Treatment of Chronic Migraine

• Published in: Headache Vol. 51; no. 1; pp. 21 - 32
• Main Authors: Cady, Roger K., Schreiber, Curtis P., Porter, John A.H., Blumenfeld, Andrew M., Farmer, Kathleen U.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.01.2011; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Botulinum Toxins, Type A - adverse effects; Botulinum Toxins, Type A - therapeutic use; Cardiovascular system; Chronic Disease; chronic migraine; Double-Blind Method; Drug therapy; Endpoint Determination; Female; Fructose - adverse effects; Fructose - analogs & derivatives; Fructose - therapeutic use; Headaches; Humans; Indexing in process; Male; Medical sciences; Middle Aged; Migraine; Migraine Disorders - prevention & control; migraine prophylaxis; Neurology; Neuromuscular Agents - adverse effects; Neuromuscular Agents - toxicity; Neuroprotective Agents - therapeutic use; onabotulinumtoxinA; Pharmacology. Drug treatments; physician global assessment; Pilot Projects; Prospective Studies; Surveys and Questionnaires; topiramate; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators; Young Adult; Blind; Headache; Topiramate; Nervous system diseases; Migraine; Physician; Cardiovascular disease; Anticonvulsant; physician global assessment; onabotulinumtoxinA; Cerebral disorder; Vascular disease; Prevention; Chronic; Pain; Treatment; migraine prophylaxis; Central nervous system disease; Neurological disorder; chronic migraine; Comparative study; Cerebrovascular disease
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2010.01796.x

(Headache 2011;51:21‐32) Objective.— This multi‐center pilot study compared the efficacy of onabotulinumtoxinA with topiramate (a Food and Drug Administration approved and widely accepted treatment for prevention of migraine) in individuals with chronic migraine (CM). Methods.— A total of 59 subjects with CM were randomly assigned to one of 2 groups: Group 1 (n = 30) received topiramate plus placebo injections, Group 2 (n = 29) received onabotulinumtoxinA injections plus placebo tablets. Subjects maintained daily headache diaries over a 4‐week baseline period and a 12‐week active study period. The primary endpoint was the Physician Global Assessment, which measured the treatment responder rate and indicated improvement in both groups over 12 weeks. Secondary endpoints, measured at weeks 4 and 12, included headache days per month, migraine days, headache‐free days, days on acute medication, severity of headache episodes, Migraine Impact & Disability Assessment, Headache Impact Test, effectiveness of and satisfaction with current treatment on the amount of medication needed, and the frequency and severity of migraine symptoms. At 12 weeks subjects were re‐evaluated and tapered off oral study medications over a 2‐week time period. Subjects not reporting a >50% reduction of headache frequency at 12 weeks were invited to participate in a 12‐week open label extension study with onabotulinumtoxinA. Of these, 20 subjects, 9 from the Topiramate Group and 11 from the OnabotulinumtoxinA Group, volunteered for this extension from weeks 14 to 26. Results.— This study demonstrated positive benefit for both onabotulinumtoxinA and topiramate in subjects with CM. Overall, the results were statistically significant within groups but not between groups. By week 26, subjects had a reduction of headache days per month compared with baseline. This was a significant within‐group finding. Conclusion.— OnabotulinumtoxinA and topiramate demonstrated similar efficacy for subjects with CM as determined by Global Physician Assessment and supported by multiple secondary endpoint measures.