Qudexy XR for Pediatric Migraine Prevention

Recruiting in Palo Alto (17 mi)

+7 other locations

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 4

Recruiting

Sponsor: Upsher-Smith Laboratories

Must not be taking: Botox, Migraine preventatives, Investigational drugs

Disqualifiers: Continuous migraines, Allergic to topiramate, others

Prior Safety Data

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

A Phase 4 study to evaluate Qudexy XR for the prevention of migraine in children 6 to 11 years of age.

Will I have to stop taking my current medications?

The trial requires that participants do not change their migraine prevention medication during the study. If you are currently taking such medication and have changed the dose within 28 days before the study, you may not be eligible.

What data supports the effectiveness of the drug Qudexy XR for preventing migraines in children?

Research shows that topiramate, the active ingredient in Qudexy XR, can significantly reduce the number of migraine days in children and lessen the impact of migraines on their daily lives. However, it may cause side effects like weight loss and tingling sensations. ^{1 2 3 4 5}

Is Qudexy XR (topiramate) safe for children?

Research shows that Qudexy XR (topiramate) has been studied for safety in children for migraine prevention and is generally considered safe, though it may have side effects. It has also been tested in adults for other conditions, showing good tolerability. ^{1 4 6 7 8}

How is Qudexy XR different from other drugs for pediatric migraine prevention?

Qudexy XR is unique because it is an extended-release form of topiramate, which allows for once-daily dosing, potentially improving convenience and adherence compared to other treatments that may require multiple doses per day. While topiramate is commonly used for adult migraines, its use in children is less common, making Qudexy XR a novel option for pediatric migraine prevention. ^{2 4 6 9 10}

Research Team

Eligibility Criteria

This trial is for children aged 6 to 11 who weigh between 17.0 kg and less than 50.0 kg, have had migraines for at least six months, and experience more than eight headache days per month. They should not have failed topiramate treatment before or be on certain contraceptives or migraine prevention medications.

Inclusion Criteria

I had 8 or more headache days in the last month.

I have had migraines for at least 6 months.

I weigh between 17.0 kg and 50.0 kg.

Exclusion Criteria

I tried topiramate for migraines for 3 months without success or had side effects.

I am menstruating and either pregnant, planning to become pregnant, breastfeeding, or using oral contraceptives without planning to switch.

I have tried more than 3 migraine prevention medications without success.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Qudexy XR or placebo for the prevention of migraine

12 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Qudexy XR (Anti-epileptic drug)

Trial Overview The study tests Qudexy XR's effectiveness in preventing migraines in kids against a placebo (a substance with no therapeutic effect). It's a Phase 4 trial, meaning the drug is already approved but needs further testing in this age group.

Participant Groups

Group I: Qudexy XR Experimental Treatment 1 Intervention

Group II: Placebo Placebo Group 1 Intervention

Who Is Running the Clinical Trial?

Upsher-Smith Laboratories

Lead Sponsor

Trials

11

Recruited

7,100+

Findings from Research

In a study involving 162 children aged 6 to 15, topiramate showed a mean reduction of 2.6 migraine days per month compared to 2.0 days for placebo, indicating a potential benefit in preventing pediatric migraines.

Topiramate was well tolerated, with low discontinuation rates due to adverse events (6.5% for topiramate vs. 4.0% for placebo), and a higher percentage of children (32%) experienced a significant reduction in migraine days compared to those on placebo (14%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Winner, P., Pearlman, EM., Linder, SL., et al.[2018]

In a study involving 97 children, topiramate significantly reduced the frequency of migraines from an average of 16.5 days per month to 9.4 days by the second follow-up, demonstrating its efficacy as a preventive treatment.

The medication was generally well-tolerated, with common side effects including cognitive issues (12.5%) and weight loss (5.6%), indicating that while effective, monitoring for side effects is important.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of topiramate in the prevention of childhood headaches. Hershey, AD., Powers, SW., Vockell, AL., et al.[2019]

Topiramate significantly reduces the number of migraine days per month and the overall migraine-related burden in children and adolescents, based on a meta-analysis of 5 randomized controlled trials involving 531 patients aged 6-17 years.

While topiramate is effective in decreasing migraine frequency, it does not significantly increase the percentage of patients experiencing a 50% reduction in headache days, and it is associated with higher rates of side effects like weight loss and paresthesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Efficacy and Safety of Topiramate in the Prevention of Pediatric Migraine: An Update Meta-Analysis. Wu, X., Zhang, Y., Lu, M., et al.[2020]

Topiramate is an effective prophylactic treatment for pediatric patients with migraines, showing a significant reduction in headache frequency of 63% to 100% at doses of 100 mg/d and 65% at 200 mg/d, with 83% to 95% of patients experiencing at least a 50% reduction in migraine rate.

The medication is generally well tolerated, although some dose-related side effects like paresthesias, weight loss, and cognitive issues were noted, making the 100 mg/d dose the most favorable in terms of benefit-to-risk ratio.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Topiramate for migraine prophylaxis in pediatric patients. Deaton, TL., Mauro, LS.[2018]

Topiramate XR, a once-daily oral medication, is effective for treating partial-onset seizures and generalized tonic-clonic seizures in patients aged 2 years and older, showing significant improvements in seizure frequency compared to placebo in a multinational phase III study.

The extended-release formulation allows for more consistent drug levels in the body and is generally well tolerated, with most side effects being mild or moderate, making it a convenient option for patients who may struggle with more frequent dosing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Topiramate Extended Release: A Review in Epilepsy. Hoy, SM.[2018]

USL255, a once-daily extended-release formulation of topiramate, demonstrated a consistent pharmacokinetic profile with predictable plasma concentrations across a wide dosing range (25-1,400 mg) in healthy adults, indicating its potential effectiveness for treating epilepsy.

The maximum tolerated dose (MTD) for USL255 was established at 1,200 mg, and the drug was generally safe and well tolerated, suggesting it could be a viable treatment option for patients with epilepsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

USL255 extended-release topiramate: dose-proportional pharmacokinetics and tolerability in healthy volunteers. Clark, AM., Halvorsen, MB., Braun, TL., et al.[2021]

In a phase III study involving 249 adults with refractory partial-onset seizures, USL255 (200 mg/day) significantly reduced seizure frequency and improved the responder rate compared to placebo, indicating its efficacy as an adjunctive treatment.

USL255 was found to be safe and well tolerated, with a low incidence of neurocognitive side effects, and it did not negatively impact the patients' quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Once-daily USL255 as adjunctive treatment of partial-onset seizures: randomized phase III study. Chung, SS., Fakhoury, TA., Hogan, RE., et al.[2021]

Topiramate, at doses of 100 or 200 mg per day, significantly reduces the frequency of migraines compared to a placebo, with a responder rate showing nearly three times the effectiveness (OR = 2.97).

While topiramate is effective in preventing migraines, it does have a higher incidence of mild to moderate adverse events compared to placebo, indicating that while it is generally safe, patients should be monitored for side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meta-analysis of efficacy of topiramate in migraine prophylaxis. Guo, Y., Han, X., Yu, T., et al.[2020]

A study involving 60 pediatric patients showed that low-dose topiramate (<2 mg/kg/day) significantly reduced migraine frequency, intensity, and duration over two months, indicating its efficacy in migraine prophylaxis.

Topiramate was well-tolerated with manageable side effects, making it a safe alternative treatment option for preventing migraines in children and adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective dose of topiramate in pediatric migraine prophylaxis. Abbaskhanian, A., Sadeghi, HR., Erfani, A., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of topiramate in the prevention of childhood headaches. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

The Efficacy and Safety of Topiramate in the Prevention of Pediatric Migraine: An Update Meta-Analysis. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Topiramate for migraine prophylaxis in pediatric patients. [2018]

5. New Zealand pubmed.ncbi.nlm.nih.gov

Topiramate Extended Release: A Review in Epilepsy. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

USL255 extended-release topiramate: dose-proportional pharmacokinetics and tolerability in healthy volunteers. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Once-daily USL255 as adjunctive treatment of partial-onset seizures: randomized phase III study. [2021]

8. India pubmed.ncbi.nlm.nih.gov

Meta-analysis of efficacy of topiramate in migraine prophylaxis. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Efficacy and tolerability of topiramate in pediatric migraine. [2018]

10. India pubmed.ncbi.nlm.nih.gov

Effective dose of topiramate in pediatric migraine prophylaxis. [2021]