Study Published in Journal Headache Shows Botox-R- May Reduce the Frequency of Headaches in Patients with a Chronic Form of Migraine.IRVINE, Calif. -- Allergan, Inc. to Move Ahead with Phase III Clinical Trials An exploratory study published today in the April 2005 issue of the journal Headache, which has been published on-line at the journal's web site http://ahsnet.org/journal/, shows that BOTOX(R) (botulinum toxin type A botulinum toxin type A Botox, Botox Cosmetic, Dysport (UK), Vistabel (UK) Pharmacologic class: Neurotoxin Therapeutic class: Neuromuscular blocker Pregnancy risk category C Action), when compared to placebo, significantly reduced the frequency of headache attacks in migraine patients suffering from chronic daily headache (CDH Congenital diaphragmatic hernia (CDH)A condition in which the fetal diaphragm—the muscle dividing the chest and abdominal cavity—does not close completely. Mentioned in: Prenatal Surgery ) - i.e., headaches and/or migraines that occur on 16 or more days each month. This Phase II study is one of multiple Phase II clinical trials that Allergan, Inc. (NYSE NYSE See: New York Stock Exchange :AGN AGN Again (Amateur Radio) AGN Active Galactic Nucleus AGN Acute Glomerulonephritis AGN Accountants Global Network AGN Air Gabon (ICAO code) ) has sponsored to explore the use of its BOTOX(R) product to treat various forms of headache in an effort to identify an appropriate protocol and patient group that will guide its Phase III program. BOTOX(R) was found to be generally well-tolerated across all studies; however, efficacy was not clearly established in several other Phase II trials which used different protocols and studied different patient groups. All Phase II study results are expected to be available in abstract or manuscript format by the end of June 2005. BOTOX(R) is not currently approved by the U.S. Food and Drug Administration (FDA FDA abbr. Food and Drug Administration FDA, n.pr See Food and Drug Administration. FDA, n.pr the abbreviation for the Food and Drug Administration. ) for the treatment of any headache disorder. Based on these Phase II findings in CDH, Allergan has reached an agreement with the FDA to move forward with a large Phase III clinical trial program, currently scheduled to begin in late 2005, to investigate the safety and efficacy of BOTOX(R) as a prophylactic therapy in a subset of migraine patients with CDH. "Patients suffering from CDH are at the most severe end of the migraine/headache spectrum(1)," said Dr. Scott Whitcup, Allergan's Executive Vice President, Research and Development. "The disability associated with this disorder can be substantial and touch every aspect of a patient's quality of life." "Little research has been dedicated to investigating prophylactic therapy in migraine patients with CDH," said Ninan T. Mathew, M.D., Director, Houston Headache Clinic, Former President of the International Headache Society The International Headache Society (IHS) is a charity organisation founded in 1981 for people from all professions that are working to treat headache disorders. It has over 1,000 ordinary members (including national society members). and American Headache Society The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and facial pain.. AHS has presented an annual headache symposium since 1970 as well as two teaching symposia a year. , and lead author of the published study. "This is the first clinical trial of its kind to assess this extremely difficult-to-treat patient population." Results of the Core Phase II Clinical Trial This was a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. , double-blind, placebo-controlled, parallel-group exploratory clinical trial designed to investigate the safety and efficacy of BOTOX(R) as a prophylactic treatment for CDH. The study involved 355 patients (84.5% female; mean age 43.5 years) who suffered from headaches on 16 or more days during the 30-day baseline period. All patients in the study experienced at least one migraine or probable migraine during the baseline period and therefore were classified as migraineurs with CDH. Patients were randomized to receive three treatments with BOTOX(R) or placebo every 90 days for nine months. The total BOTOX(R) dose range was 105 to 260 units per treatment. The between-group difference on the primary efficacy measure (i.e., change from baseline in the number of headache-free days) did not reach statistical significance (BOTOX(R) 6.7 vs. placebo 5.2, p=0.30). Significant differences compared to placebo were demonstrated on other key efficacy measures, including: --Within 30 days following the first treatment, BOTOX(R)-treated patients experienced significantly fewer headaches than placebo-treated patients, an effect that was sustained throughout the nine-month study. The difference was greatest at day 180, when BOTOX(R)-treated patients experienced an average of 7.1 fewer headache attacks per 30 day period, compared to 3.7 fewer attacks among placebo-treated patients (p=0.001). --In addition, a significantly higher percentage of BOTOX(R)-treated patients had a decrease from baseline of greater than or equal to 50% in the frequency of headache days. --Differences on key efficacy measures in favor of BOTOX(R) were even more evident in a subgroup analysis of study patients who were not taking other prophylactic medications to treat their headaches.(2) In addition, these patients had a significant decrease in the use of acute medication to treat their headache pain compared to placebo-treated patients. Treatment with BOTOX(R) was generally well-tolerated in the studied population of migraine patients with CDH. 2.3% (4/173) of BOTOX(R)-treated patients discontinued from the study due to reported treatment-related adverse events. The most frequently reported treatment-related adverse events among BOTOX(R)-treated patients were muscular weakness (22%), neck pain (13.3%), headache (6.9%) and blepharoptosis (6.9%). The most frequently reported treatment-related adverse events in the placebo group were headache (6%) and injection-site hemorrhage (4.9%). "The results from studies in headache and migraine are sometimes difficult to interpret because of confounding factors such as the simultaneous use of other migraine medications, as well as the high placebo response rates that are common to pain trials in general," said David W. Dodick, M.D., Department of Neurology, Mayo Clinic College of Medicine in Arizona, involved in Allergan's BOTOX(R) Phase II program design, and one of the lead investigators for its Phase III program. About Chronic Daily Headache Between 12 and 15 million Americans currently suffer from CDH, a highly disabling headache disorder characterized by 16 or more days of headache per month.(3) In headache specialty clinics, it is estimated that 80% of all CDH patients are migraine patients whose condition has evolved into a chronic form of frequent headache.(4) There are no therapies approved by regulatory authorities specifically for the prophylactic treatment of migraine patients with CDH. Classes of drugs currently used for this purpose include beta-blockers, calcium channel blockers Calcium Channel Blockers Definition Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. , serotonin antagonists, antidepressants Antidepressants Medications prescribed to relieve major depression. Classes of antidepressants include selective serotonin reuptake inhibitors (fluoxetine/Prozac, sertraline/Zoloft), tricyclics (amitriptyline/ Elavil), MAOIs (phenelzine/Nardil), and heterocyclics , nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Definition Nonsteroidal anti-inflammatory drugs are medicines that relieve pain, swelling, stiffness, and inflammation. , and antiepileptic drugs. About BOTOX(R) BOTOX(R) is a medical product that contains tiny amounts of highly purified botulinum toxin protein refined from a bacterium. The product is administered in small therapeutic doses by injection directly into the affected area, and works by blocking the overactive o·ver·ac·tive adj. Active to an excessive or abnormal degree: an overactive child. o nerve. BOTOX(R) therapy was granted approval by the FDA in 1989 for the treatment of strabismus strabismus (strəbĭz`məs), inability of the eyes to focus together because of an imbalance in the muscles that control eye movement; also called squint. (crossed eyes) and blepharospasm bleph·a·ro·spasm n. Spasmodic winking caused by the involuntary contraction of an eyelid muscle. blepharospasm spasm of the orbicularis oculi muscle of the eyelid. (uncontrollable eye blinking) associated with dystonia dystonia /dys·to·nia/ (-to´ne-ah) dyskinetic movements due to disordered tonicity of muscle.dyston´ic dystonia musculo´rum defor´mans , including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above. BOTOX(R) has since received approval in December 2000 for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia. In 2002, with dosing specific to treat frown lines between the eyebrows, the product was approved by the FDA for the temporary improvement in the appearance of moderate to severe glabellar lines (the vertical "frown lines" between the eyebrows) in adult men and women aged 65 and younger, under the name BOTOX(R) Cosmetic. More recently, in July 2004, BOTOX(R) was granted FDA approval for the treatment of severe primary axillary ax·il·lar·y n. Relating to the axilla. Axillary Located in or near the armpit. Mentioned in: Mastectomy axillary of or pertaining to the armpit. hyperhidrosis (excessive underarm un·der·arm adj. Located, placed, or used under the arm. n. The armpit. sweating) that is inadequately managed with topical agents. In the U.S., BOTOX(R) is currently being investigated for the treatment of additional medical conditions, including migraine and headache, post-stroke spasticity spasticity /spas·tic·i·ty/ (spas-tis´i-te) the state of being spastic; see spastic (2). spas·tic·i·ty n. 1. A spastic state or condition. 2. Spastic paralysis. , and overactive bladder. Important Risk Information BOTOX(R) and BOTOX(R) Cosmetic treatment is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity hypersensitivity, heightened response in a body tissue to an antigen or foreign substance. The body normally responds to an antigen by producing specific antibodies against it. The antibodies impart immunity for any later exposure to that antigen. to any ingredient in the formulation. Serious and/or immediate hypersensitivity reactions have been rarely reported. These reactions include anaphylaxis anaphylaxis (ăn'əfəlăk`sĭs), hypersensitive state that may develop after introduction of a foreign protein or other antigen into the body tissues. , urticaria urticaria /ur·ti·ca·ria/ (ur?ti-kar´e-ah) hives; a vascular reaction of the upper dermis marked by transient appearance of slightly elevated patches (wheals) which are redder or paler than the surrounding skin and often attended by , soft tissue edema edema (ĭdē`mə), abnormal accumulation of fluid in the body tissues or in the body cavities causing swelling or distention of the affected parts. , and dyspnea. If such a reaction occurs further injection of BOTOX(R) should be discontinued and appropriate medical therapy immediately instituted. BOTOX(R) and BOTOX(R) Cosmetic should only be diluted with 0.9 percent non-preserved sodium chloride. Individuals with peripheral motor neuropathic diseases (e.g., amyotrophic lateral sclerosis amyotrophic lateral sclerosis (ALS) (ā'mīətrōf`ik, sklĭrō`sĭs) or motor neuron disease, , or motor neuropathy) or neuromuscular junctional disorders (e.g., myasthenia gravis myasthenia gravis (mīəsthē`nēə grä`vĭs), chronic disorder of the muscles characterized by weakness and a tendency to tire easily. or Lambert-Eaton syndrome) should only receive BOTOX(R) or BOTOX(R) Cosmetic with caution. Patients with neuromuscular disorders may be at increased risk of clinically significant systemic effects including severe dysphagia dysphagia /dys·pha·gia/ (-fa´jah) difficulty in swallowing. dys·pha·gia or dys·pha·gy n. Difficulty in swallowing or inability to swallow. and respiratory compromise from typical doses of BOTOX(R) or BOTOX(R) Cosmetic. There have been rare reports of adverse events involving the cardiovascular system, including arrhythmia arrhythmia (ārĭth`mēə), disturbance in the rate or rhythm of the heartbeat. Various arrhythmias can be symptoms of serious heart disorders; however, they are usually of no medical significance except in the presence of and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established. BOTOX(R) for Blepharospasm in Patients greater than or equal to 12 Years of Age: Reduced blinking from BOTOX(R) injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect and corneal perforation. The most frequently reported treatment-related adverse reactions in these patients are ptosis Ptosis Definition Ptosis is the term used for a drooping upper eyelid. Ptosis, also called blepharoptosis, can affect one or both eyes. Description The eyelids serve to protect and lubricate the outer eye. (20.8%), superficial punctate keratitis (6.3%) and eye dryness (6.3%). BOTOX(R) for Strabismus in Patients greater than or equal to 12 Years of Age: Inducing paralysis in one or more extraocular muscles may produce spatial disorientation, double vision or past pointing. The most commonly reported adverse effects are ptosis (16%) and vertical deviation (17%). BOTOX(R) for Cervical Dystonia in Adults: There have been rare cases of dysphagia severe enough to warrant the insertion of a gastric feeding tube. The most frequently reported adverse reactions in patients with cervical dystonia are dysphagia (19%), upper respiratory infection Noun 1. upper respiratory infection - infection of the upper respiratory tract respiratory infection, respiratory tract infection - any infection of the respiratory tract (12%), neck pain (11%), and headache (11%). BOTOX(R) for Severe Primary Axillary Hyperhidrosis Inadequately Managed with Topical Agents: Patients should be evaluated for potential causes of secondary hyperhidrosis (e.g., hyperthyroidism hyperthyroidism: see thyroid gland. ) to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease. The most frequently reported adverse events (3 - 10%) are injection site pain and hemorrhage, non-axillary sweating, infection, pharyngitis pharyngitis Inflammation and infection (usually bacterial or viral) of the pharynx. Symptoms include pain (sore throat, worse on swallowing), redness, swollen lymph nodes, and fever. , flu syndrome, headache, fever, neck or back pain, pruritus pruritus /pru·ri·tus/ (proo-ri´tus) itching.prurit´ic pruritus a´ni intense chronic itching in the anal region. pruritus hiema´lis xerotic eczema. , and anxiety. BOTOX(R) Cosmetic for Temporary Improvement in the Appearance of Frown Lines between the Brows: The most frequently reported adverse events are headache (13.3%), respiratory infection (3.5%), flu syndrome (2%), blepharoptosis (3.2%) and nausea (3%). Full prescribing information for BOTOX(R) and BOTOX(R) Cosmetic is available at www.botox.com and www.botoxcosmetic.com. Forward-Looking Statements This press release contains "forward-looking statements," including, among other statements, the statements by Dr. Whitcup, Dr. Mathew and Dr. Dodick, statements regarding research and development and regulatory outcomes, efficacy, adverse event profiles, and market and product potential. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize, actual results could vary materially from Allergan's expectations and projections. Risks and uncertainties include general industry and pharmaceutical market conditions; general domestic and international economic conditions, such as interest rate and currency exchange rate fluctuations; technological advances and patents obtained by competitors; challenges inherent in product marketing such as the unpredictability of market acceptance for new pharmaceutical and biologic products and/or the acceptance of new indications for such products; domestic and foreign health care reforms; the timing and uncertainty of the research and development and regulatory processes; trends toward managed care and health care cost containment; and governmental laws and regulations affecting domestic and foreign operations. Allergan expressly disclaims any intent or obligation to update these forward-looking statements except as required to do so by law. Additional information concerning these and other risk factors can be found in press releases issued by Allergan, as well as Allergan's public periodic filings with the Securities and Exchange Commission, including the discussion under the heading "Certain Factors and Trends Affecting Allergan and its Businesses" in Allergan's 2004 Form 10-K. Copies of Allergan's press releases and additional information about Allergan is available on the World Wide Web at www.allergan.com or you can contact the Allergan Investor Relations Department by calling 1-714-246-4636. About Allergan, Inc. Allergan, Inc., with headquarters in Irvine, California, is a technology-driven, global health care company providing specialty pharmaceutical products worldwide. Allergan develops and commercializes products in the eye care, neuromodulator, skin care and other specialty markets that deliver value to its customers, satisfy unmet medical needs, and improve patients' lives.
(1)International Headache Society, 2004
(2)Dodick DW, Mauskop A, Elkind AH, DeGryse R, Brin MF, Silberstein
SD. Botulinum toxin type A for the prophylaxis of chronic daily
headache: subgroup analysis of patients not receiving other
prophylactic medication (a randomized double-blind,
placebo-controlled study). Headache 2005: in press.
(3)Castillo J, Munoz P, Guitera V, Pascual J. Epidemiology of chronic
daily headache in the general population. Headache
1999;39:190-196.
(4)Castillo J, Munoz P, Guitera V, Pascual J. Epidemiology of chronic
daily headache in the general population. Headache
1999;39:190-196.
|
|
||||||||||||||||

Printer friendly
Cite/link
Email
Feedback
Reader Opinion