Pooled Phase 3 Studies Highlight AXS-07 as Effective Migraine Treatment

Stewart J. Tepper, MD

At the 2024 American Academy of Neurology (AAN) Annual Meeting, held April 13-18 in Denver, Colorado, presented data from a pooled analysis of the phase 3 MOMENTUM (NCT03896009) and INTERCEPT (NCT04163185) trials indicated that AXS-07 (Axsome Therapeutics) was effective at acutely treating migraine. All told, treatment with the investigational agent resulted in significant reductions in headache pain freedom, migraine symptoms, and rescue medication use.¹

AXS-07, a novel, oral, rapidly absorbed, multi-mechanistic medicine, is thought to act by inhibiting calcitonin gene-related peptide (CGRP) release, reversing CGRP-mediated vasodilation, and inhibiting neuroinflammation, pain signal transmission, and central sensitization. In the pooled analysis, results showed that AXS-07 demonstrated greater headache pain freedom (23% vs 11%; P <.001) and absence of the most bothersome symptom (MBS)(39% vs 25%; P <.001) at 2 hours compared with placebo.

The investigational agent consists of MoSEIC (Molecular Solubility Enhanced Inclusion Complex) meloxicam and rizatriptan. Meloxicam is a new molecular entity for migraine enabled by MoSEIC technology, which results in rapid absorption of meloxicam while maintaining a long plasma half-life. AXS-07 remains investigational, as the FDA issued Axsome a complete response letter for its new drug application submission in May 2022, citing issues related to the chemistry, manufacturing, and controls considerations.

The analysis, led by Stewart J. Tepper, MD, professor of neurology at the Geisel School of Medicine at Dartmouth, showed that patients on AXS-07 had improved sustained pain freedom between 2 and 24 hours (18% vs 8%; P <.001) and 48 hours (16% vs 7%; P <.001). In addition, 43% of AXS-07-treated patients had reduced rescue medication use through 24 hours vs 21% of those on placebo (P <.001). Notably, a higher rate of patients on the investigational agent returned to normal functioning in comparison with placebo starting at 1-hour post-dose.

MOMENTUM and INTERCEPT were the 2 main studies behind the 2022 new drug application submission of AXS-07. In MOMENTUM, 1594 patients with migraine were randomly assigned 2:2:2:1 to AXS-07, 10-mg rizatriptan, MoSEIC 20-mg meloxicam, or placebo, to treat a single migraine attack of moderate or severe intensity. INTERCEPT included 302 patients with migraine who were randomly assigned to either AXS-07 (n = 152) or placebo (n = 150) at the earliest onset of migraine pain.

READ MORE: American Headache Society Calls for CGRP Medications to be Considered as First-Line Migraine Preventive Treatments

In the pooled analysis, treatment emergent adverse events (TEAEs) were reported by 12.7% of those on AXS-07 and 6.6% on placebo. The most common TEAEs found in AXS-07-treated individuals were nausea, somnolence, and dizziness.

In the original MOMENTUM trial, AXS-07 met its coprimary end points with statistical significance, first showing a greater percentage of patients achieving pain freedom (19.9%) compared with placebo (6.7%; P <.001). Second, the absence of the MBS (36.9%) compared with placebo (24.4%) was significant (P = .002). On secondary end points, AXS-07 showed significant numbers of patients achieving pain-freedom (16.1%) compared with the rizatriptan, MoSEIC meloxicam, and placebo groups, respectively (11.2%, 8.8%, and 5.3%), with all comparisons being significant (P = .038; P = .001; P <.001, respectively).²

In April 2020, months after the initial readout of MOMENTUM, Axsome announced positive results from INTERCEPT. The coprimary end points were also identical to MOMENTUM, with a statistically significantly greater percentage of patients achieving pain freedom compared with placebo (32.6% vs 16.3%, respectively; P = .002) at 2 hours post dose, as well as freedom from the most bothersome symptom (43.9% vs 26.7%, respectively; P = .003).4 AXS-07 also showed efficacy in preventing progression of migraine pain beyond mild intensity and significantly reducing the use of rescue medication, with freedom of pain progression occurring in 73.5% of AXS-07-treated patients compared with 47.4% of placebo patients between 2 and 24 hours post dose (P <.001).³

AXS-07 is currently being assessing in another phase 3 study, EMERGE (NCT05550207), which evaluates efficacy and safety among those with migraine who have experienced an inadequate response to oral CGRP inhibitors. The unique trial, announces in September 2022, enrolls 100 patients who will receive open-label AXS-07 for 8 weeks for at-home treatment of their next 4 migraine attacks. Data from the study will be used to further elucidate the clinical profile of AXS-07 and is not a regulatory requirement.⁴

Click here for more coverage of AAN 2024.

REFERENCES
1. Tepper S. Lipton R, Chhabra A, Streicher C, Parks G, Tabuteau H. Combined efficacy and safety of AXS-07 (MOSEICTM Meloxicam and Rizatriptan) in two phase 3 clinical trials. Presented at: 2024 AAN Annual Meeting; April 13-18; Denver, CO. Abstract 00519
2. Axsome Therapeutics Announces AXS-07 Achieves Co-Primary and Key Secondary Endpoints in MOMENTUM Phase 3 Migraine Trial in Patients with History of Inadequate Response. News release. Axsome Therapeutics. December 30, 2019. Accessed April 12, 2024. https://www.biospace.com/article/releases/axsome-therapeutics-announces-axs-07-achieves-co-primary-and-key-secondary-endpoints-in-momentum-phase-3-migraine-trial-in-patients-with-history-of-inadequate-response
3. Axsome Therapeutics announces AXS-07 achieves both co-primary endpoints and prevents migraine pain progression in the INTERCEPT phase 3 trial in the early treatment of migraine. news release. Axsome Therapeutics. April 6, 2020. Accessed April 12, 2024. https://www.finance.yahoo.com/news/axsome-therapeutics-announces-axs-07-100010869.html
4. Axsome Therapeutics initiates EMERGE phase 3 open-label trial of AXS-07 for the acute treatment of migraine in adults with a prior inadequate response to an oral CGRP inhibitor. News release. Axsome Therapeutics. September 1, 2022. Accessed April 12, 2024. https://www.globenewswire.com/en/news-release/2022/09/01/2508374/33090/en/Axsome-Therapeutics-Initiates-EMERGE-Phase-3-Open-Label-Trial-of-AXS-07-for-the-Acute-Treatment-of-Migraine-in-Adults-with-a-Prior-Inadequate-Response-to-an-Oral-CGRP-Inhibitor.html