Functionality, satisfaction, and global impression of change with ubrogepant for the acute treatment of migraine in triptan insufficient responders: a post hoc analysis of the ACHIEVE I and ACHIEVE II randomized trials.

BACKGROUND: Triptans are the first-line option for the acute treatment of migraine attacks; however, triptans are contraindicated in people with certain underlying cardiovascular risk factors and are associated with inadequate efficacy or poor tolerability in some individuals. Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine. METHODS: This post hoc analysis of the phase 3 ACHIEVE trials examined the impact of ubrogepant on the Functional Disability Scale (FDS), satisfaction with medication, and Patient Global Impression of Change (PGIC) in participants who were self-reported triptan insufficient responders (TIRs), defined as those who are unable to take triptans due to contraindications, tolerability issues, or insufficient efficacy. Responder definitions for the FDS, satisfaction measures, and PGIC were based on qualitative interpretation of the respective response options for the pooled ubrogepant 50 mg and placebo groups. RESULTS: In the pooled analysis population (n = 1799), 451 (25%) participants were TIRs, with most (80%) reporting insufficient efficacy with triptan use. A significantly higher proportion of TIRs treated with ubrogepant vs placebo reported being able to function normally from 2 to 8 h post dose (P < 0.05). Notably, significance was demonstrated at the time of the primary outcome assessments (2 h post dose), where rates of normal function were 38% for ubrogepant vs 29% for placebo (P = 0.048). A greater proportion of TIRs in the ubrogepant arm vs the placebo arm were satisfied with treatment at 2 (33% vs 21%, P = 0.006) and 24 h (58% vs 28%, P < 0.001) and indicated that their migraine improved at 2 h vs placebo (30% vs 18%, P = 0.006). Results were generally similar in the insufficient efficacy subpopulation of TIRs as in the overall TIRs group. Ubrogepant was safe and well tolerated in TIRs, with no new safety signals identified. CONCLUSIONS: In people with migraine who are TIRs, individuals treated with ubrogepant had favorable 2-h outcomes, as measured by the FDS, satisfaction with medication, and PGIC, compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02828020 (ACHIEVE I), registered July 11, 2016; NCT02867709 (ACHIEVE II), registered August 16, 2016.

Efficacy and safety of memantine in children with autism spectrum disorder: Results from three phase 2 multicenter studies.

Three phase 2 trials were conducted to assess the efficacy and long-term safety of weight-based memantine extended release (ER) treatment in children with autism spectrum disorder. MEM-MD-91, a 50-week open-label trial, identified memantine extended-release treatment responders for enrollment into MEM-MD-68, a 12-week randomized, double-blind, placebo-controlled withdrawal trial. MEM-MD-69 was an open-label extension trial in which participants from MEM-MD-68, MEM-MD-91, and open-label trial MEM-MD-67 were treated ⩽48 weeks with memantine extended release. In MEM-MD-91, 517 (59.6%) participants were confirmed Social Responsiveness Scale responders at week 12; mean Social Responsiveness Scale total raw scores improved two to three times a minimal clinically important difference of 10 points. In MEM-MD-68, there was no difference between memantine and placebo on the primary efficacy parameter, the proportion of patients with a loss of therapeutic response (defined as ⩾10-point increase from baseline in Social Responsiveness Scale total raw score). MEM-MD-69 exploratory analyses revealed mean standard deviation improvement in Social Responsiveness Scale total raw score of 32.4 (26.4) from baseline of the first lead-in study. No new safety concerns were evident. While the a priori-defined efficacy results of the double-blind trial were not achieved, the considerable improvements in mean Social Responsiveness Scale scores from baseline in the open-label trials were presumed to be clinically important.

Differential contributions of vision and proprioception to movement accuracy.

We examined the relative roles of visual and proprioceptive information about initial hand position on movement accuracy. A virtual reality environment was employed to dissociate visual information about hand position from the actual hand position. Previous studies examining the effects of such dissociations on perception of hand location have indicated a bias toward the visually displayed position. However, an earlier study, which employed optical prisms to dissociate visual and proprioceptive information prior to targeted movements, suggested a bias in movement direction toward that defined by the actual hand position. This implies that visual and proprioceptive information about hand position may be differentially employed for perceptual judgments and movement planning, respectively. We now employ a virtual reality environment to systematically manipulate the visual display of the hand start position from the actual hand position during movements made to a variety of directions. We asked whether subjects would adjust their movements in accord with the virtual or the actual hand location. Subjects performed a series of baseline movements toward one of three targets in each of three blocks of trials. Interspersed among these trials were "probe" trials in which the cursor location, but not the hand location, was displaced relative to the baseline start position. In all cases, cursor feedback was blanked at movement onset. Our findings indicated that subjects systematically adjusted the direction of movement in accord with the virtual, not the actual, start location of the hand. These findings support the hypothesis that visual information about hand position predominates in specifying movement direction.

Effects of altering initial position on movement direction and extent.

The purpose of this study was to examine the relative influence of initial hand location on the direction and extent of planar reaching movements. Subjects performed a horizontal-plane reaching task with the dominant arm supported above a table top by a frictionless air-jet system. A start circle and a target were reflected from a horizontal projection screen onto a horizontally positioned mirror, which blocked the subject's view of the arm. A cursor, representing either actual or virtual finger location, was only displayed between each trial to allow subjects to position the cursor in the start circle. Prior to occasional "probe trials," we changed the start location of the finger relative to the cursor. Subjects reported being unaware of the discrepancy between cursor and finger. Our results indicate that regardless of initial hand location, subjects did not alter the direction of movement. However, movement distance was systematically adjusted in accord with the baseline target position. Thus when the hand start position was perpendicularly displaced relative to the target direction, neither the direction nor the extent of movement varied relative to that of baseline. However, when the hand was displaced along the target direction, either anterior or posterior, movements were made in the same direction as baseline trials but were shortened or lengthened, respectively. This effect was asymmetrical such that movements from anterior displaced positions showed greater distance adjustment than those from posterior displaced positions. Inverse dynamic analysis revealed substantial changes in elbow and shoulder muscle torque strategies for both right/left and anterior/posterior pairs of displacements. In the case of right/left displacements, such changes in muscle torque compensated changes in limb configuration such that movements were made in the same direction and to the same extent as baseline trials. Our results support the hypothesis that movement direction is specified relative to an origin at the current location of the hand. Movement extent, on the other hand, appears to be affected by the workspace learned during baseline movement experience.