Efficacy, safety, and tolerability of telcagepant in the treatment of acute migraine: a meta-analysis.

Abstract

Although triptans are widely used for treating acute migraine, they are contraindicated or not effective in a large proportion of patients. Hence, alternative treatments are needed. Calcitonin gene-related peptide receptor antagonists, such as telcagepant, have been under investigation as a treatment for acute migraine. A meta-analysis of the efficacy of telcagepant vs. placebo and triptans (zolmitriptan or rizatriptan) was performed. Randomized controlled trials were indentified from databases using the following search terms: migraine; calcitonin gene-related peptide; calcitonin gene-related peptide receptor antagonists; efficacy; safety, and telcagepant. The primary outcome measure was pain freedom 2 hours after first treatment. The secondary outcome measure was pain relief 2 hours after first treatment. Eight trials were included in the meta-analysis (telcagepant = 4011 participants). The difference in pain freedom at 2 hours significantly favored telcagepant over placebo (odds ratio = 2.70, 95% confidence interval = 2.27-3.21, P < 0.001) and triptans over telcagepant (odds ratio = 0.68, 95% confidence interval = 0.56-0.83, P < 0.001). The difference in pain relief at 2 hours significantly favored telcagepant over placebo (odds ratio = 2.48, 95% confidence interval = 2.18-2.81, P < 0.001). The difference in pain relief at 2 hours did not significantly favor telcagepant over triptans or vice versa (odds ratio = 0.76, 95% confidence interval = 0.57-1.01, P = 0.061). These findings indicate that telcagepant can be effective for treating acute migraine. Calcitonin gene-related peptide receptor antagonists represent a potentially important alternative means of treating acute migraine.

• Authors: Xiao-ping Cui, Jian-xin Ye, Hang Lin, Jun-shan Mu, Min Lin
• Journal: Pain practice : the official journal of World Institute of Pain (Pain Pract) Vol. 15 Issue 2 Pg. 124-31 (Feb 2015) ISSN: 1533-2500 [Electronic] United States
• PMID: 24382126 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: © 2013 World Institute of Pain.

Chemical References

• Azepines
• Calcitonin Gene-Related Peptide Receptor Antagonists
• Imidazoles
• Oxazolidinones
• Serotonin 5-HT1 Receptor Agonists
• Triazoles
• Tryptamines
• zolmitriptan
• rizatriptan
• telcagepant

Topics

• Acute Disease
• Azepines (therapeutic use)
• Calcitonin Gene-Related Peptide Receptor Antagonists
• Humans
• Imidazoles (therapeutic use)
• Migraine Disorders (drug therapy)
• Oxazolidinones (therapeutic use)
• Serotonin 5-HT1 Receptor Agonists (therapeutic use)
• Treatment Outcome
• Triazoles (therapeutic use)
• Tryptamines (therapeutic use)