Prescribed medications are no more effective than a sugar pill when used to prevent migraines in children and teens.
A study published Oct. 27 in The New England Journal of Medicine shows no significant differences among amitriptyline, topiramate, and placebo in reducing headache days or related disability.
“The study was intended to demonstrate which of the commonly used preventive medications in migraine was the most effective. What we found is that we could prevent these headaches with either a medication or a placebo,” says Andrew Hershey, MD, PhD, co-director of the Cincinnati Children’s Headache Center and senior author of the study. “This study suggests that a multi-disciplinary approach and the expectation of response is the most important, not necessarily the prescription provided.”
Researchers conducted the Childhood and Adolescent Migraine Prevention (CHAMP) study at 31 sites in the United States.
Cincinnati Children’s served as the Clinical Coordinating Center (CCC) for the study, and was responsible for all clinical oversight activities. The Clinical Trials Statistical and Data Management Center (CTSDMC) at the University of Iowa served as the Data Coordinating Center for the study. It had primary responsibility for data management, implementing the electronic data capture system, and all statistical aspects of the study.
Interpreting the Results
“The interpretation of these results is very challenging. In most situations, trials that fail to show benefit of an intervention do so because study participants do not improve. That was not the situation here. A majority of all study participants improved, regardless of their assigned treatment group,” says Chris Coffey, PhD, director of the CTSDMC and professor of biostatistics in the University of Iowa’s College of Public Health, and lead statistician for the study. “Further research is needed to better understand the results and to determine what future strategies might optimize the treatment of headaches in these childhood and adolescent populations.”
The 24-week clinical trial included 328 eligible patients. The trial used a clinically meaningful endpoint of a 50 percent or greater reduction in headache days from the 28 days prior to randomization to the final four weeks of the 24-week study. Sixty-one percent of those on a placebo saw the days they had a headache reduced by 50 percent or more.
For the two medication groups, 52 percent of those taking amitriptyline and 55 percent of those taking topiramate had this level of reduced headache days. The responder rates were not statistically different between the three groups.
Compared to placebo, those on the two active drugs had a significantly higher rate of side effects, including fatigue, dry mouth and, in three cases, mood alteration. Thirty-one percent of those on topiramate had paresthesia – a “pins and needles” tingling in the hands, arms, legs or feet.
The results raise questions about the best way to prevent migraines, particularly given that it’s unethical to prescribe a placebo without the patient’s knowledge, according to the authors. They add it’s likely the expectation of responding to a medication may override the actual biochemical and pharmacological changes that are thought to occur with pharmacotherapy.
Major pediatric headache centers, such as Cincinnati Children’s, incorporate a multi-disciplinary approach that includes acute therapy, preventive therapy and behavioral treatment in a systematic approach, says Hershey. The CHAMP study incorporated this approach across all 31 study sites to ensure uniformity.
“Our national team was hoping to develop evidence to drive the choice by medical providers of the first line prevention medication for helping youth with migraine, but the data showed otherwise, says Scott Powers, PhD, pediatric psychologist, co-director of the headache center at Cincinnati Children’s, and first author of the paper. “We see this as an important opportunity for health care providers, scientists, children, and families because our findings suggest a paradigm shift. First line prevention treatment will involve a multidisciplinary team approach and focus on non-pharmacological aspects of care. The good news is we can help children with migraines get better.”
Powers says the study also underscores the importance of conducting more research with a developmental focus on children and young adults. This will allow innovations that can be applied directly to a chronic illness of childhood.
The study was supported by the National Institute of Neurological Disorders and Stroke and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health through grants U01NS076788 and U01NS077108.
Jeffrey D. Dawson and Christopher S. Coffey from the University of Iowa College of Public Health have been named 2016 Fellows of the American Statistical Association (ASA), the nation’s preeminent professional statistical society. Dawson is professor of biostatistics and associate dean for faculty affairs, and Coffey is professor of biostatistics and director of the Clinical Trials Statistical and Data Management Center (CTSDMC).
To be recognized as an ASA Fellow, each honoree must make outstanding professional contributions to and have exhibited leadership in the field of statistical science.
Dawson was recognized for his significant contributions to research in driving safety and cardiovascular health; for innovative methodological advances in the analysis of longitudinal, ordinal, and categorical data; and for service to the profession.
Coffey was honored for contributions to the design and analysis of clinical trials; for leadership in the coordination and conduct of clinical trials; for outstanding education and mentoring of statisticians, scientists, and clinical trialists; and for outstanding leadership and service to ASA and the profession.
They will be officially recognized at an awards ceremony August 2, 2016, during the Joint Statistical Meetings (JSM 2016) in Chicago.
The designation of ASA Fellow has been a significant honor for nearly 100 years. Under ASA bylaws, the Committee on Fellows can elect up to one-third of one percent of the total membership as fellows each year. Individuals are nominated by their peers in the association membership.
To be honored, nominees must have an established reputation and have made outstanding contributions in statistical science. The Committee on Fellows evaluates each candidate’s contributions to the advancement of statistical science and places due weight to published works, the position held with their employer, ASA activities, membership and accomplishments in other societies and other professional activities.
The American Statistical Association is the world’s largest community of statisticians and the second-oldest continuously operating professional society in the United States. Its members serve in industry, government and academia in more than 90 countries, advancing research and promoting sound statistical practice to inform public policy and improve human welfare.
The 2016 College of Public Health Awards Program was held April 28, honoring the research, teaching, and service achievements of faculty and staff. Congratulations to this year’s honorees!
New Faculty Research Award
- Wei Bao, Assistant Professor, Epidemiology
- Dan Sewell, Assistant Professor, Biostatistics
Faculty Research Award
- Marcia Ward, Professor, Health Management & Policy
Faculty Service Award
- Chris Coffey, Professor, Biostatistics
Faculty Teaching Award
- Miesha Marzell, Assistant Professor, Community & Behavioral Health
- Tanya Uden-Holman, Clinical Professor and Associate Dean for Academic Affairs
Staff Research Award
- Kim Merchant, Research Associate, Health Management & Policy
Staff Service Award
- Margaret Evans, Administrator, Biostatistics
For the first time, the American Heart Association/American Stroke Association recommends using a stent retrieval device to remove blood clots in select stroke patients who have clots obstructing the large arteries supplying blood to the brain, according to a new focused update published in the American Heart Association journal Stroke. Chris Coffey, CPH professor of biostatistics, is a co-author of the updated guidelines.
The optimal initial treatment for a clot-caused (ischemic) stroke remains intravenous delivery of the clot-busting medication tissue plasminogen activator (tPA). When given within a few hours after stroke symptoms, tPA can dissolve the clot and reestablish blood flow to the brain, limiting stroke disability.
“What we’ve learned in the last eight months, from six new clinical trials, is that some people will benefit from additional treatment with a stent retrieval device if a clot continues to obstruct one of the big vessels after tPA is given,” said William J. Powers, M.D., lead author of the focused update and H. Houston Merritt distinguished professor and chair of the department of neurology at the University of North Carolina at Chapel Hill.
The focused update on endovascular treatment of acute ischemic stroke analyzes results from randomized clinical trials published since 2013, when the last treatment guidelines were issued.
On May 9, Chris Coffey, professor of biostatistics and director of the Clinical Trials Statistical Data Management Center, traveled to Des Moines with colleagues from the UI Department of Neurology to take part in Muscular Dystrophy Association (MDA) Awareness Night with the Iowa Cubs.
Chris reports: “The Cubs wore special MDA-themed uniforms, and the central Iowa MDA chapter held a silent auction during the game where fans could bid on and purchase the actual uniforms worn by the players during the game. Since May is also amyotrophic lateral sclerosis (ALS) awareness month, the MDA had a box at the game and they invited us to meet with individuals and families throughout the state that have been affected by ALS. It was a nice experience, and we were able to answer a lot of their questions about the state of ALS research in a very relaxed environment. Laurie Gutmann [UI professor of neurology] and I were also interviewed by the Cubs radio announcers on-air during the third inning of the game!”
Chris Coffey, professor of biostatistics and director of the Clinical Trials Statistical and Data Management Center, has been named a Fellow of the Society for Clinical Trials (SCT). Kathryn Chaloner, former professor and head of biostatistics, has also been posthumously named a Fellow.
The honor of SCT Fellow is bestowed to Society members who have made significant contributions to the advancement of clinical trials and to the Society. The formal presentation of the SCT Class of 2015 Fellows will be held on Monday, May 18, 2015, at the SCT 36th Annual Meeting.
The Society for Clinical Trials is an international professional organization dedicated to the development and dissemination of knowledge about the best practice in design, conduct, analysis, and reporting of clinical trials.
For more information on the SCT, see http://www.sctweb.org/public/home.cfm.
Several researchers from the University of Iowa attended a meeting in Chicago the weekend of Dec. 6 that focused on exercise and Parkinson’s disease. The meeting, organized by Ergun Uc, UI associate professor of neurology, specifically sought to evaluate the current state of the art and look towards future clinical trials to examine the benefits of exercise in this population.
Attending from the College of Public Health were Chris Coffey, director of the Clinical Trials Statistical and Data Management Center (CTSDMC) and professor of biostatistics, along with Dixie Ecklund, CTSDMC associate director, and Jeff Dawson, professor of biostatistics. Other UI faculty attending were Michelle Voss (psychology) and Warren Darling (health and human physiology).
The Clinical Trials Statistical Data Management Center (CTSDMC) in the Department of Biostatistics celebrated its 25th Anniversary on Oct. 28, 2014. The center’s first director, Robert “Skip” Woolson, gave a talk outlining the center’s founding in 1989. Many former employees and collaborators were in attendance. Christopher Coffey, the current CTSDMC director, presented the current state of the CTSDMC, highlighting the center’s participation in the NIH-funded Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) and the Clinical Islet Transplantation Consortium, now in its tenth year.
The afternoon was devoted to honoring William Clarke, CTSDMC associate director (1989-2000) and director (2000-2010), for his outstanding leadership and service to the University of Iowa. College of Public Health Dean Sue Curry spoke of Clarke’s interdisciplinary contributions in the use of statistical methods in clinical trial design and analysis and in biomedical research. She also noted his long record of contribution to clinical trial methodology as well as classroom teaching and university service. She then unveiled the “William R. Clarke Conference Suite” in 2500 UCC. In addition, Joseph Cavanaugh, interim head of biostatistics, spoke of Clarke’s contributions to teaching and research, and dedicated the Graduate Student Assistant Award in the Department of Biostatistics to Clarke for his 50+ years of service to biostatistics and the University of Iowa.