title: 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.affiliation: Department of Neurology, Fuzhou General Hospital of Nanjing Command, PLA and Clinical Medical College of Fujian Medical University, Fuzhou, China.
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Cui
authors.forename: Jian-xin
authors.initials: JX
authors.lastname: Ye
authors.forename: Hang
authors.initials: H
authors.lastname: Lin
authors.forename: Jun-shan
authors.initials: JS
authors.lastname: Mu
authors.forename: Min
authors.initials: M
authors.lastname: Lin
mesh_terms: D000208:Acute Disease; D001381:Azepines / Q000627:therapeutic use*; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008881:Migraine Disorders / Q000188:drug therapy*; D023303:Oxazolidinones / Q000627:therapeutic use; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D001381:Azepines; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D007093:Imidazoles; D023303:Oxazolidinones; D058825:Serotonin 5-HT1 Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C089750:zolmitriptan; C093622:rizatriptan; C525458:telcagepant
keywords: analgesia; calcitonin gene-related peptide receptor antagonist; cranial pain; efficacy; headache; meta-analysis; migraine; safety; telcagepant