Migraine Drug Has Similar Effects in Patient Subgroups

The footprint of efficacy of telcagepant may be a little different from the footprint of efficacy of the triptans, which would be a great thing if it were so, said Dr. Kelman, who has been a speaker for Merck and other companies that manufacture migraine drugs.

Among patients who reported that previous treatment with a non-steroidal anti-inflammatory drug was of “no use,” 53% of 443 patients on lower-dose telcagepant, 57% of 418 on higher doses, and 26% of 484 patients on placebo were free of pain after 2 hours.

Response After Prior Opioid Use

A post-hoc analysis of data from a randomized, double-blind placebo-controlled trial suggests that patients with or without a prior response to opioid treatment for migraines might respond similarly to telcagepant. Among 111 patients who reported at least a 75% response to prior opioid therapy, 64% of those who took telcagepant 140 mg for a migraine attack and 69% on 280 mg were pain-free after 2 hours, compared with 54% on placebo.

Among 243 patients who reported less than a 75% response to prior opioid therapy, telcagepant brought pain relief at 2 hours in 54% of patients who received 140 mg and in 55% of patients on 280 mg, compared with 26% of patients on placebo. Among 1,163 patients with no history of opioid use for migraine, freedom from pain at 2 hours was reported by 60% on 140-mg telcagepant, 56% on 280-mg telcagepant, and 32% on placebo, Dr. Ho and his associates reported.

Signals of Low Abuse Potential

Thirty-six healthy recreational polydrug users were randomized in a double-blind, six-period crossover study to evaluate their liking for single doses of placebo or telcagepant 280 mg, 560 mg, 1,120 mg, or 1.5 mg or 3 mg of alprazolam as a positive control known to have abuse potential. Patient ratings on a Drug Liking visual analogue scale showed no significant differences between telcagepant and placebo, while alprazolam was ranked significantly higher than telcagepant or placebo, reported Rebecca Blanchard, Ph.D., also of Merck Research Laboratories, and her associates.

Efficacy Unchanged in Combination

Combining telcagepant with ibuprofen or acetaminophen did not significantly change efficacy in a pilot randomized, double-blind, placebo-controlled study, reported Dr. David J. Hewitt of Merck Research Laboratories and his associates.

Pain freedom at 2 hours was reported by 35% of 145 patients who took telcagepant 280 mg plus ibuprofen 400 mg, 38% of 133 patients who took the same telcagepant dose plus acetaminophen 1,000 mg, 31% who got telcagepant alone, and 11% who received placebo.

The footprint of efficacy of telcagepant may be a little different from the footprint of efficacy of the triptans.

Source DR. KELMAN