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 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.