Efficacy, Safety, and Tolerability of Telcagepant in the Treatment of Acute Migraine: A meta-Analysis

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 2hours after first treatment. The secondary outcome measure was pain relief 2hours after first treatment. Eight trials were included in the meta-analysis (telcagepant=4011 participants). The difference in pain freedom at 2hours 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 2hours 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 2hours 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.