Amitriptyline and Topiramate in the Prevention of Childhood Migraine: DCC

描述(申请人提供)：美国有600多万儿童和青少年患有偏头痛，大多数人在成年后仍会经历偏头痛。在美国，偏头痛每年造成的经济影响为360亿美元(直接医疗成本+生产力损失)。由于偏头痛，每两周就有超过13万个上学日缺课。然而，没有FDA批准的儿童偏头痛预防药物，儿科临床实践指南是基于共识，而不是基于证据。中心问题是缺乏安慰剂对照的临床试验和预防性药物治疗的比较有效性研究。为了解决这个问题，我们建议进行阿米替林和托吡酯预防儿童偏头痛的试验。这一关键的儿科项目将在一次临床试验中解决三个关键问题。总而言之，这些结果将改变临床医生可用的知识库，并提供改变和优化实践所需的重要证据。由于阿米替林(AMI)和托吡酯(TPM)是儿童头痛专家常用的药物，但目前缺乏被推荐为美国神经病学学会实践参数I类证据的经验数据，前两个问题涉及这两种药物相对于安慰剂的有效性、耐受性和安全性。第三个问题是，这两种药物在有效性、耐受性和安全性方面如何比较，这是第一次针对儿童的问题。我们的目标是使用专门为该项目开发的决策算法来确定儿童偏头痛预防药物治疗的首选方案。我们将对675名8岁至17岁的偏头痛儿童和青少年进行一项三组随机、双盲、平行组、安慰剂对照试验，测试AMI和TPM，这些儿童和青少年来自全美40个地点。参与者将以2：2：1的方式随机分组(急性心肌梗死[N=270]；TPM[N=270]；安慰剂[N=135])，并将接受为期24周的预防性药物治疗或安慰剂。主要终点将是在这项为期24周的临床试验的最后4周内，偏头痛频率从基线(通过每日疼痛日记衡量)减少50%。关键的次要终点将是偏头痛相关的残疾、耐受性和安全性。

DESCRIPTION (provided by applicant): Migraine affects more than 6 million children and adolescents in the United States and the majority continue to experience migraines into adulthood. The annual economic impact of migraine in the U.S. is $36 billion (direct medical costs + lost productivity). Over 130,000 school days are missed every two weeks due to migraine. Yet, no prevention medication is FDA-approved for childhood migraine and pediatric clinical practice guidelines are consensus-based, not evidence-based. The central problem is the lack of placebo-controlled clinical trials and comparative effectiveness studies of prophylactic medication therapy. To address this problem, we propose the 'Amitriptyline and Topiramate in the Prevention of Childhood Migraine' Trial. This pivotal pediatric project will address three critical questions in one clinical trial. Collectively, the results will transform the knowledge base available to clinicians and provide vital evidence needed to change and optimize practice. Because amitriptyline (AMI) and topiramate (TPM) are commonly used by pediatric headache specialists, but currently lack the empirical data to be recommended as Class I evidence in the American Academy of Neurology practice parameters, the first two questions address the efficacy, tolerability, and safety of the two medications relative to placebo. The third question asks, for the first time with children, how these two medications compare to each other in terms of efficacy, tolerability, and safety. Our goal is to determine the first choice prevention medication therapy for pediatric migraine using a decision algorithm developed specifically for this project. We will conduct a 3-arm, randomized, double-blind, parallel group, placebo-controlled trial testing AMI and TPM with 675 children and adolescents between age 8 and 17 with migraine recruited from up to 40 sites across the United States. Participants will be randomized in a 2:2:1 fashion (AMI [N=270]; TPM [N=270]; Placebo [N=135]) and will receive prevention medication therapy or placebo for 24 weeks. The primary endpoint will be a > 50% reduction in migraine frequency from baseline (measured by daily pain diary) during the final 4 weeks of this 24-week clinical trial. Key secondary endpoints will be migraine-related disability, tolerability, and safety.