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This is a randomized, double-blind, multi-center, parallel-group study designed to compare the safety and efficacy of a range of doses of ZP-Zolmitriptan intracutaneous microneedle systems to placebo.
This is a randomized, double-blind, multi-center, parallel group study designed to compare the safety and efficacy of a range of doses of ZP-Zolmitriptan intracutaneous microneedle systems to placebo. Subjects who have consented and meet the entry criteria will be randomized to one of four blinded treatment groups. There will be a screening period of up to 1 week, followed by a run-in period to record migraine activity. The run-in period is to determine eligibility for randomization, and is planned to be 4 weeks in duration but may be extended up to an additional 4 weeks to accommodate scheduling. Qualified subjects will randomize to the double-blind treatment period at Day 0 and will have up to 8 weeks to confirm and treat a qualifying migraine. Using the eDiary to confirm they are experiencing a qualified migraine, subjects will self-administer the patch or patches and continue to respond to questions in the eDiary for 48 hours post treatment administration.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ZP-Zolmitriptan 1 mg | Experimental | ZP-Zolmitriptan 1 mg patch single administration |
|
| ZP-Zolmitriptan 1.9 mg | Experimental | ZP-Zolmitriptan 1.9 mg patch single administration |
|
| ZP-Zolmitriptan 3.8 mg | Experimental | ZP-Zolmitriptan 3.8 mg (1.9 mg x 2 patches) single administration |
|
| Placebo | Placebo Comparator | Placebo (either single or double patch) single administration |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ZP-Zolmitriptan | Drug | ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of Subjects With Pain Freedom | Pain Freedom at 2 hours post study drug administration is one of the co-primary endpoints. Subjects were queried via their eDiary about their level of migraine pain (none, mild, moderate, or severe) at various intervals post-dose. Subjects who answered none at 2 hours post study drug were considered pain free at 2 hours. | 2 hours |
| Proportion of Subjects With Freedom From Most Bothersome Pre-specified Other Symptom (Nausea, Photophobia, or Phonophobia Pre-specified by Subject) | The proportion of subjects with freedom from the subject's pre-specified most bothersome symptom at 2 hours is one of two parts of the co-primary efficacy endpoint. This endpoint will be evaluated separately but both endpoints have to be met statistically for the study to be considered a success. | 2 hours |
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Inclusion Criteria:
Greater than 1 year history of episodic, acute migraine (with or without aura) with onset prior to 50 years of age. Diagnosis must comply with International Headache Society (IHS) diagnostic criteria. Diagnostic criteria must include a history of at least five attacks not attributed to any other disorder that include all of the following criteria:
(i) unilateral location (ii) pulsating quality (iii) moderate or severe pain intensity (iv) aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs) c) During headache at least one of the following: (i) nausea and/or vomiting (ii) both photophobia and phonophobia
Migraine history during the 6-month period prior to the run-in period must include: 2-8 migraines per month and no more than 10 headache days per month
Women of child-bearing potential must not be pregnant, must agree to avoid pregnancy during the trial, and must use an acceptable methods of birth control for the duration of the trial.
No significant ECG findings, defined by:
Able to understand the operation of the electronic diary and is able to apply the demo study drug patch.
Exclusion Criteria:
Contraindication to triptans
Use of any prohibited concomitant medications within 10 days of the Run-in Period
History of hemiplegic or basilar migraine
Participation in another investigational trial during the 30 days prior to the Run-in Period or during this study
Previous participation in a clinical trial of ZP-Zolmitriptan
Diagnosis of cancer (other than non-invasive skin cancer) within the 5 years prior to the Run-in Period
History of unstable psychiatric illness requiring medication or hospitalization in the 12 months prior to the Run-in Period
Subjects who have known allergy or sensitivity to zolmitriptan or its derivatives or formulations
Subjects who have known allergy or sensitivity to adhesives
Planned participation in activities which cause inflammation, irritation, sunburn, lesions, or tattoos at the intended application site from two weeks prior to screening through the last day of study participation
Use of opiate analgesics or barbiturates more frequently than one day/week
Women who are pregnant, breast-feeding or plan a pregnancy during this study
Clinically significant liver disease
Clinically significant kidney disease
History of coronary artery disease (CAD), coronary vasospasm (including Prinzmetal's angina), aortic aneurysm, peripheral vascular disease or other ischemic diseases (e.g., ischemic bowel syndrome or Raynaud's syndrome)
Three or more of the following CAD risk factors:
History of cerebral vascular accident, transient ischemic attacks, or seizures
Hospitalization within the 30 days prior to the Run-in Period
Any other household member currently participating in a ZP-Zolmitriptan study or relatives of site staff
Any reason to believe that compliance with the study requirements and completion of evaluations required for this study will not be possible
History or current abuse or dependence on alcohol or drugs that would interfere with adherence to study requirements
Any clinically relevant abnormal findings in the physical exam, vital signs or laboratory tests that, in the opinion of the Investigator, may put the subject at risk
To be eligible for Treatment, subjects must continue to meet all eligibility criteria and the following criteria observed during the Run-in Period:
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| Name | Affiliation | Role |
|---|---|---|
| Donald Kellerman, Pharm.D. | Zosano Pharma Corporation | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Research Advantage, Inc./Thunderbird Internal Medicine | Glendale | Arizona | 85306 | United States | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30698272 | Derived | Tepper SJ, Dodick DW, Schmidt PC, Kellerman DJ. Efficacy of ADAM Zolmitriptan for the Acute Treatment of Difficult-to-Treat Migraine Headaches. Headache. 2019 Apr;59(4):509-517. doi: 10.1111/head.13482. Epub 2019 Jan 30. | |
| 29022755 | Derived | Spierings EL, Brandes JL, Kudrow DB, Weintraub J, Schmidt PC, Kellerman DJ, Tepper SJ. Randomized, double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine. Cephalalgia. 2018 Feb;38(2):215-224. doi: 10.1177/0333102417737765. Epub 2017 Oct 12. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo | Placebo (either single or double patch) single administration Placebo: Placebo patch(es) to match ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system (one or two patches) |
| FG001 | ZP-Zolmitriptan 1 mg |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Placebo | Drug | Placebo patch(es) to match ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system (one or two patches) |
|
| The Research Center of Southern California |
| Carlsbad |
| California |
| 92011 |
| United States |
| Allergy and Asthma Specialists Medical Group and Research Center | Huntington Beach | California | 92647 | United States |
| Downtown LA Research Center | Los Angeles | California | 90017 | United States |
| Allergy & Asthma Associates of Southern California | Mission Viejo | California | 92691 | United States |
| Allergy and Asthma Associates of Santa Clara Valley Research Center | San Jose | California | 95117 | United States |
| California Medical Clinic for Headache | Santa Monica | California | 90404 | United States |
| Empire Clinical Research | Upland | California | 91786 | United States |
| Colorado Allergy & AsthmaCenters, PC | Denver | Colorado | 80230 | United States |
| Ki Health Partners | Stamford | Connecticut | 06905 | United States |
| Avail Clinical Research, LLC | DeLand | Florida | 32720 | United States |
| Medical Research Group of Central Florida | Orange City | Florida | 32763 | United States |
| Meridien Research | Tampa | Florida | 33634 | United States |
| Clinical Research Atlanta | Stockbridge | Georgia | 30281 | United States |
| Boston Clinical Trials | Boston | Massachusetts | 02131 | United States |
| Novex Medical Research | New Bedford | Massachusetts | 02740 | United States |
| Northeast Medical Research Associates, Inc. | North Dartmouth | Massachusetts | 02714 | United States |
| MedVadis Research Corporation | Watertown | Massachusetts | 02472 | United States |
| Michigan Head Pain &Neurological Institute | Ann Arbor | Michigan | 48104 | United States |
| Westside Family Medical Center, P.C | Kalamazoo | Michigan | 49009 | United States |
| Clinical Research Institute, Inc. | Minneapolis | Minnesota | 55402 | United States |
| Clinvest/A Division of Banyan Group Inc. | Springfield | Missouri | 65807 | United States |
| The Clinical Research Center, LLC | St Louis | Missouri | 63141 | United States |
| Nebraska Medical Research Institute | Bellevue | Nebraska | 68123 | United States |
| Dartmouth-Hitchcock Medical Center | Lebanon | New Hampshire | 03756 | United States |
| Princeton Center for Clinical Research | Skillman | New Jersey | 08558 | United States |
| Headache Wellness Center, PC | Greensboro | North Carolina | 27405 | United States |
| Peters Medical Research LLC | High Point | North Carolina | 27262 | United States |
| North Carolina Clinical Research | Raleigh | North Carolina | 27607 | United States |
| PMG Research of Raleigh | Raleigh | North Carolina | 27609 | United States |
| CTI Clinical Research Center | Cincinnati | Ohio | 45227 | United States |
| Coastal Carolina Research Center | Mt. Pleasant | South Carolina | 29464 | United States |
| Nashville Neurosciences Group | Nashville | Tennessee | 37203 | United States |
| Central Texas Health Research | New Braunfels | Texas | 78130 | United States |
| Sylvana Research Associates | San Antonio | Texas | 78229 | United States |
| Charlottesville Medical Research Center LLC | Charlottesville | Virginia | 22911-3568 | United States |
ZP-Zolmitriptan 1 mg patch single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system |
| FG002 | ZP-Zolmitriptan 1.9 mg | ZP-Zolmitriptan 1.9 mg patch single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system |
| FG003 | ZP-Zolmitriptan 3.8 mg | ZP-Zolmitriptan 3.8 mg (1.9 mg x 2 patches) single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system |
| COMPLETED |
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| NOT COMPLETED |
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mITT population
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| ID | Title | Description |
|---|---|---|
| BG000 | Placebo | Either single or double patch administration |
| BG001 | ZP-Zolmitriptan 1 mg | Single 1 mg patch administration |
| BG002 | ZP-Zolmitriptan 1.9 mg | Single 1.9 mg patch administration |
| BG003 | ZP-Zolmitriptan 3.8 mg | Double 1.9 mg patch administration |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Proportion of Subjects With Pain Freedom | Pain Freedom at 2 hours post study drug administration is one of the co-primary endpoints. Subjects were queried via their eDiary about their level of migraine pain (none, mild, moderate, or severe) at various intervals post-dose. Subjects who answered none at 2 hours post study drug were considered pain free at 2 hours. | mITT population includes all subjects who were randomized, received any amount of study drug (applied the patch(es) to treat a qualifying migraine, and had at least 1 post-treatment efficacy assessment | Posted | Count of Participants | Participants | 2 hours |
|
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| |||||||||||||||||||||||||||||||||||
| Primary | Proportion of Subjects With Freedom From Most Bothersome Pre-specified Other Symptom (Nausea, Photophobia, or Phonophobia Pre-specified by Subject) | The proportion of subjects with freedom from the subject's pre-specified most bothersome symptom at 2 hours is one of two parts of the co-primary efficacy endpoint. This endpoint will be evaluated separately but both endpoints have to be met statistically for the study to be considered a success. | mITT | Posted | Count of Participants | Participants | 2 hours |
|
2-8 days post-study drug administration for a single migraine
The number of subjects at risk includes only subjects who treated with study drug (333). Although 365 subjects were randomized, not all subjects had a migraine (a criterion for administering study drug) between randomization and the end of the trial. 32 subjects (8 in the placebo group, 10 in ZP-Zolmitriptan 1 mg, 5 in ZP-Zolmitriptan 1.9 mg, 9 in ZP-Zolmitriptan 3.8 mg) did not treat with study drug, and that is the difference between the number of subjects randomized and the number at risk.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | Placebo (either single or double patch) single administration Placebo: Placebo patch(es) to match ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system (one or two patches) | 0 | 83 | 0 | 83 | 15 | 83 |
| EG001 | ZP-Zolmitriptan 1 mg | ZP-Zolmitriptan 1 mg patch single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system | 0 | 80 | 0 | 80 | 26 | 80 |
| EG002 | ZP-Zolmitriptan 1.9 mg | ZP-Zolmitriptan 1.9 mg patch single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system | 0 | 87 | 0 | 87 | 37 | 87 |
| EG003 | ZP-Zolmitriptan 3.8 mg | ZP-Zolmitriptan 3.8 mg (1.9 mg x 2 patches) single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system | 0 | 83 | 0 | 83 | 43 | 83 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Application site erythema | General disorders | Systematic Assessment |
| ||
| Application site bruise | General disorders | Systematic Assessment |
| ||
| Application site pain | General disorders | Systematic Assessment |
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| Application site haemorrhage | General disorders | Systematic Assessment |
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| Application site swelling | General disorders | Systematic Assessment |
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| Application site oedema | General disorders | Systematic Assessment |
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| Dizziness | Nervous system disorders | Non-systematic Assessment |
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| Paraesthesia | Nervous system disorders | Non-systematic Assessment |
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| Muscle tightness | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
| ||
| Nausea | Gastrointestinal disorders | Systematic Assessment |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Donald Kellerman | Zosano Pharma Corporation | (510) 745-4004 | dkellerman@zosanopharma.com |
| ID | Term |
|---|---|
| D008881 | Migraine Disorders |
| ID | Term |
|---|---|
| D051270 | Headache Disorders, Primary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Male |
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| Not Hispanic or Latino |
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| Unknown or Not Reported |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
|
| OG003 | ZP-Zolmitriptan 3.8 mg | ZP-Zolmitriptan 3.8 mg (1.9 mg x 2 patches) single administration ZP-Zolmitriptan: ZP-Zolmitriptan single administration delivered via intracutaneous microneedle patch delivery system |
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