Randomized, controlled trial of telcagepant over four migraine attacks

Area of Science:

• Neurology
• Pharmacology

Background:

• Migraine is a debilitating neurological disorder.
• Calcitonin gene-related peptide (CGRP) receptor antagonists represent a novel therapeutic target for migraine treatment.

Purpose of the Study:

• To evaluate the efficacy and consistency of the CGRP receptor antagonist telcagepant for acute treatment of migraine attacks.
• To assess telcagepant's effectiveness across multiple migraine attacks in a randomized, double-blind study.

Main Methods:

• Adults with moderate-to-severe migraine were randomized to receive telcagepant (140 mg or 280 mg) or placebo for up to four attacks.
• Efficacy was assessed for the first attack and for consistency of response across multiple attacks.
• Key endpoints included pain freedom, pain relief, and absence of migraine-associated symptoms.

Main Results:

• Both telcagepant doses (140 mg and 280 mg) significantly improved pain freedom, pain relief, and reduced migraine-associated symptoms compared to placebo after the first attack.
• Consistent efficacy in pain freedom and pain relief was significantly higher with telcagepant treatment sequences versus control.
• Adverse events such as somnolence and vomiting were reported at a higher incidence with telcagepant compared to placebo, but were generally mild.

Conclusions:

• Telcagepant (140 mg and 280 mg) is effective for the acute treatment of migraine attacks.
• Telcagepant demonstrated more consistent efficacy than placebo for intermittent treatment of up to four migraine attacks.
• The CGRP receptor antagonist telcagepant was generally well tolerated in this patient population.