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Migraine Abortive Telcagepant Performs Well In Trials

by Teri Robert, Lead Expert

Last year, we looked at Phase II clinical trials of MK-0974, an investigational oral calcitonin gene-related pepitide (CGRP) receptor antagonist, a new type of Migraine abortive. That medication has now been named telcagepant, and is showing great promise as a new Migraine abortive. When I spoke with lead researcher, Dr. Tony Ho, last year, he commented "MK-0974 has a novel new mechanism for relief. Nearly 70% get pain relief at two hours. The results are excellent for sustained relief at 24 hours. The adverse even rate is similar to placebo."

In the latest Phase III study, telcagepant proved safe and effective in treating Migraines and caused fewer side effects than Zomig.

Study details:

  • Included 1,380 patients at 81 sites in the United States and Europe.
  • Patients suffered from moderate to severe Migraine.
  • Patients were given 150 or300 mg of telcagepant, 5 mg of Zomig, or placebo.

Study results:

  • Telcagepant 300 mg and Zomig 5 mg were similarly effective in relieving Migraine.
  • Both telcagepant 300 mg and Zomig 5 mg were more effective than 150 mg of telcagepant.
  • Negative side effects were reported by:
    • 31% of patients receiving telcagepant 150 mg
    • 32 % of patients receiving placebo
    • 37% of patients receiving telcagepant 300 mg
    • 51% of patients receiving Zomig  mg

Authors' study interpretation:

"Telcagepant 300 mg is effective as an acute treatment for migraine with efficacy comparable to that of zolmitriptan 5 mg, but with fewer associated adverse effects."

How does Telcagepant differ from triptans?

Triptans such as Imitrex, Maxalt, Zomig, etc., are selective serotonin receptor agonists. They work by binding to different combinations of serotonin receptors. They are Migraine abortive drugs; they work in the brain to actually stop the Migrainous process and abort the Migraine in progress. Although they're usually well tolerated, some people experience side effects such as dizziness, through tightness, and chest discomfort (not heart related in most patients). Also, because triptans have a vasoconstrictive action intended to return dilated blood vessels to normal, it's recommended that triptans not be used by patients with uncontrolled hypertension,  a history of or high risk factors for cardiovascular disease, or those with hemiplegic or basilar-type Migraine.

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