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A study, multi-center, randomized, double-blind, placebo parallel-controlled method, will be carried out to evaluate the safety and efficacy of Botulinum Toxin Type A for injection (HengLi®) for prophylactic treatment with chronic migraine in adults. In the core phase, two treatments of HengLi® or the placebo will be administrated (randomized at a ratio of 2:1, the target number is 288 subjects). In the extension phase, three treatments of HengLi® will be still administrated on 288 subjects recruited ever.
Subjects in the core phase will be randomized into two groups: Botulinum Toxin Type A (HengLi®) (155U to 195U) or placebo. Study include a 28-day baseline screening period, a 24-week core phase with 2 administrations, and a 32-week extension phase with 3 administrations .Subjects enrolled will get a e-headache-diary in recording their headache symptoms and acute headache medications.
HengLi® was administered as 31 fixed-site, fixed-dose (5U), i.m. injections across 7 specific head/neck muscle areas every 12 weeks (weeks 0, 12, 24, 36, and 48). At the investigator's discretion, up to 40 U of additional HengLi® could have been administered among 3 muscle groups (occipitalis, temporalis, or trapezius) using a protocol-defined paradigm. Hence the maximum dose per treatment cycle was 195 U over 39 sites.
Efficacy Outcome Measures should be evaluated by headache diary, HIT-6 score and MIDAS score . The primary Outcome Measure: Change from baseline in the average number of days with headache per month (The last 4 weeks during the core phase and the 4 weeks during the baseline period should be compared with the number of headache days per month on average.)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Botulinum Toxin Type A for Injection | Active Comparator | Botulinum Toxin Type A is a specific formulation of a locally injected muscle relaxant whose active ingredient is botulinum toxin type A produced by clostridium botulinum A strain Hall. Excipients contain sucrose, dextran and gelatin. |
|
| Placebo | Placebo Comparator | The placebo does not include botulinum toxin A ,but includes sucrose, dextran and gelatin. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Botulinum Toxin Type A for Injection | Drug | In these studies ,patients received a minimum intramuscular (IM) dose of 155 U of Botulinum Toxin Type A(HengLi®)administered to 31 injection sites across 7 head and neck muscles using a fixed-site, fixed-dose injection paradigm (each injection was 5 U in 0.1 mL). In addition, up to 40 U Botulinum Toxin Type A,administered IM to 8 additional injection sites across 3 head and neck muscles, was allowed, using a follow-the-pain approach. Thus, the minimum dose was 155 U and the maximum dose was 195 U. In the core phase, two doses of HengLi® will be injected.In the extension phase, three doses of HengLi® will be injected. |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in average number of days with headache per month | The last 4 weeks during the core phase and the 4 weeks during the baseline period should be compared with the number of headache days per month on average. | Baseline (week -4 to 0) and core phase (week 21 to 24) |
| Measure | Description | Time Frame |
|---|---|---|
| the average number of days with headache per month | Change in the average number of days with headache per month versus the baseline | Baseline and Week 4, 8, 12, 16, 20, 28, 32, 36, 40, 44, 48, 52, 56 |
| the average frequency of headache per month |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sheng yuan Yu | The General Hospital of People's Liberation Army(301 hospital) | Study Director |
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| ID | Term |
|---|---|
| D019274 | Botulinum Toxins, Type A |
| D007267 | Injections |
| C000595968 | Hengli BTX-A |
| ID | Term |
|---|---|
| D001905 | Botulinum Toxins |
| D008666 | Metalloendopeptidases |
| D010450 | Endopeptidases |
| D010447 | Peptide Hydrolases |
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| Placebo | Drug | In these studies, patients received placebo administered to 31 injection sites across 7 head and neck muscles using a fixed-site, fixed-dose injection paradigm (each injection was 0.1 mL). In addition, up to 0.8 mL placebo, administered IM to 8 additional injection sites across 3 head and neck muscles, was allowed, using a follow-the-pain approach. In the core phase, two doses of placebo will be injected. |
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Change in the average frequency of headache per month versus the baseline
| Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| the average frequency of migraine per month | Change in the average frequency of migraine per month versus the baseline | Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| Proportions of subjects | Proportions of subjects with a reduction in the average frequency of migraine per month≥50% and ≥30% | Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| Change in the average frequency of needing emergency analgesics per month | The number of days with the need of emergency analgesics during the observation period divided by the number of days in the observation period and multiplied by 28. The need of emergency analgesics refers to use of analgesics in case of attacks or use of drugs in advance to prevent pain attacks. | Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| Change in the average severity of migraine | Sum of severity scores of migraine episodes during the observation period divided by the number of migraine episodes. The severity of each migraine episode is the severity when the pain is the fiercest, expressed using VAS (0-10). | Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| Change in the average duration of migraine | Sum of durations of migraine episodes during the observation period divided by the number of migraine episodes. | Baseline and Week 4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| Migraine Disability Assessment Questionnaire score(MIDAS) | Change in the MIDAS per month versus the baseline | Week 0,12,24,36,48,56 |
| Headache Impact Test (HIT) | Change in the HIT per month versus the baseline | Week0,4,8,12,16,20,24,28,32,36,40,44,48,52,56 |
| D006867 |
| Hydrolases |
| D004798 | Enzymes |
| D045762 | Enzymes and Coenzymes |
| D045726 | Metalloproteases |
| D001426 | Bacterial Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D001427 | Bacterial Toxins |
| D014118 | Toxins, Biological |
| D001685 | Biological Factors |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |