Originally published on MPR - Monthly Prescribing Reference.
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Results of a post-hoc analysis of data from a randomized, double-blind, placebo-controlled trial suggest the answer is "no," specifically regarding efficacy of telcagepant, a novel investigational oral calcitonin gene-related peptide receptor antagonist that has acute antimigraine efficacy comparable to oral triptans.
Andrew P. Ho, MD, and colleagues from Merck Research Laboratories, North Wales, Pa., reviewed patient-completed migraine history questionnaires that asked the percentage of moderate or severe migraine headaches that responded to opioid treatment (75-100%, 50-74%, 25-49%, <25%, did not know, or did not use opioids), and whether opioids had ever previously been used to treat a migraine headache.
Based on replies to the questionnaire, four patient subgroups were categorized. Subgroup 1 identified a response in ≥75% of opioid-treated attacks; subgroup 2 had a response in <75% of opioid-treated attacks; subgroup 3 was opioid-naïve, and subgroup 4 had not used opioids to treat a migraine headache but had used opioids previously.
Percentages of patients reporting 2-hour pain freedom for the telcagepant 140 mg dose were 21.4% in subgroup 1 (9/42 patients); 20.0% in subgroup 2 (16/80); 23.2% in subgroup 3 (91/393); and 17.9% in subgroup 4 (5/28). For the telcagepant 280 mg dose, 2-hour pain freedom was 25.0% in subgroup 1 (9/36 patients); 22.5% in subgroup 2 (20/89); 26.5% in subgroup 3 (100/378); and 7.1% in subgroup 4 (1/14).
Those reporting 2-hour pain relief (defined as reduction to mild or none) for the telcagepant 140 mg dose were 64.3% in subgroup 1 (27/42 patients); 53.8% in subgroup 2 (43/80); 59.5% in subgroup 3 (234/393); and 67.9% in subgroup 4 (19/28). For the telcagepant 280 mg dose, 2-hour pain relief was 69.4% in subgroup 1 (25/36 patients); 55.1% in subgroup 2 (49/89); 56.3% in subgroup 3 (213/378); and 57.1% in subgroup 4 (8/14). Please see corresponding PowerPoint slides for more information.
These findings, suggesting that telcagepant efficacy is similar regardless of whether patients used-or previously responded to-opioids, require confirmation in prospective studies, the investigators reported during the American Pain Society's 29th Annual Scientific Meeting.