Is there an inherent limit to the efficacy of calcitonin gene-related peptide receptor antagonists in the acute treatment of migraine? A comment.
Calcitonin gene-related peptide (CGRP) receptor antagonists are a new treatment principle in acute migraine attacks. Intravenous olcegepant 2.5 mg resulted in 66% headache relief after 2 h, whereas subcutaneous sumatriptan resulted in 81-92% headache relief after 2 h. The intrinsic activity of a parenteral triptan, a 5HT(1B/1D) receptor agonist, is thus higher than the maximum effect of the parenteral CGRP receptor antagonist olcegepant. For the orally bioavailable CGRP antagonist telcagepant 300 mg, the headache relief was only 55% in one phase III study. These results indicate that CGRP receptor antagonism results in success in the acute treatment of migraine in only a certain fraction of the patients.
Tfelt-Hansen
Peer C
PC
Danish Headache Centre, Glostrup Hospital, Glostrup, Denmark. ptha@glo.regionh.dk
D001381:Azepines / Q000494:pharmacology* / Q000627:therapeutic use; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D002536:Cerebral Arteries / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D002986:Clinical Trials as Topic; D004151:Dipeptides / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology* / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D010879:Piperazines; D011799:Quinazolines / Q000494:pharmacology* / Q000627:therapeutic use; D018015:Receptors, Calcitonin Gene-Related Peptide / Q000378:metabolism; D017366:Serotonin Receptor Agonists / Q000494:pharmacology / Q000627:therapeutic use; D017211:Treatment Failure; D014363:Tryptamines / Q000494:pharmacology / Q000627:therapeutic use
D001381:Azepines; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D004151:Dipeptides; D007093:Imidazoles; D010879:Piperazines; D011799:Quinazolines; D018015:Receptors, Calcitonin Gene-Related Peptide; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; C525458:telcagepant; D015740:Calcitonin Gene-Related Peptide; C406305:olcegepant