Optimal Balance of Efficacy and Tolerability of Oral Triptans and Telcagepant: a Review and a Clinical Comment

Overview

Journal J Headache Pain

Publisher Biomed Central

Date 2011 Feb 26

PMID 21350792

Citations 3

Authors

Peer Tfelt-Hansen

Affiliations

Soon will be listed here.

Abstract

Dose-response curves for headaches relief and adverse events (AEs) are presented for five triptans: sumatriptan, zolmitriptan, naratriptan, almotriptan, and frovatriptan, and the CGRP antagonist telcagepant. The upper part of the efficacy curve of the triptans is generally flat, the so-called ceiling effect; and none of the oral triptans, even in high doses, are as effective as subcutaneous sumatriptan, In contrast, AEs increases with increasing dose without a ceiling effect. The optimal dose for the triptans is mainly determined by tolerability. Telcagepant has an excellent tolerability and can be used in migraine patients with cardiovascular co-morbidity. Based on the literature the triptans and telcagepant are rated in a table for efficacy and tolerability.

Citing Articles

Long-term treatment with lasmiditan in patients with migraine: post hoc analysis of treatment patterns and outcomes from the open-label extension of the CENTURION randomized trial.

Komori M, Ozeki A, Tanji Y, Kamiki E, Krege J, Li L J Headache Pain. 2024; 25(1):43.

PMID: 38528476 PMC: 10964539. DOI: 10.1186/s10194-024-01745-y.

CGRP receptor antagonists and antibodies against CGRP and its receptor in migraine treatment.

Edvinsson L Br J Clin Pharmacol. 2015; 80(2):193-9.

PMID: 25731075 PMC: 4541967. DOI: 10.1111/bcp.12618.

A pharmaco-fMRI study on pain networks induced by electrical stimulation after sumatriptan injection.

Yuan W, Dan L, Netra R, Shaohui M, Chenwang J, Ming Z Exp Brain Res. 2013; 226(1):15-24.

PMID: 23329206 DOI: 10.1007/s00221-013-3405-8.

References

EDMEADS J, Millson D . Tolerability profile of zolmitriptan (Zomig; 311C90), a novel dual central and peripherally acting 5HT1B/1D agonist. International clinical experience based on > 3000 subjects treated with zolmitriptan. Cephalalgia. 1997; 17 Suppl 18:41-52. DOI: 10.1177/0333102497017S1806. View

Pfaffenrath V, Cunin G, Sjonell G, Prendergast S . Efficacy and safety of sumatriptan tablets (25 mg, 50 mg, and 100 mg) in the acute treatment of migraine: defining the optimum doses of oral sumatriptan. Headache. 1998; 38(3):184-90. DOI: 10.1046/j.1526-4610.1998.3803184.x. View

Visser W, Terwindt G, Reines S, Jiang K, Lines C, Ferrari M . Rizatriptan vs sumatriptan in the acute treatment of migraine. A placebo-controlled, dose-ranging study. Dutch/US Rizatriptan Study Group. Arch Neurol. 1996; 53(11):1132-7. DOI: 10.1001/archneur.1996.00550110072014. View

Havanka H, Dahlof C, Pop P, Diener H, Winter P, Whitehouse H . Efficacy of naratriptan tablets in the acute treatment of migraine: a dose-ranging study. Naratriptan S2WB2004 Study Group. Clin Ther. 2000; 22(8):970-80. DOI: 10.1016/s0149-2918(00)80068-5. View

Dahlof C, Tfelt-Hansen P, Massiou H, Fazekas A . Dose finding, placebo-controlled study of oral almotriptan in the acute treatment of migraine. Neurology. 2001; 57(10):1811-7. DOI: 10.1212/wnl.57.10.1811. View

Tfelt-Hansen P . Unpublished clinical trials with sumatriptan. Lancet. 2009; 374(9700):1501-2. DOI: 10.1016/S0140-6736(09)61906-1. View

Ferrari M, Roon K, Lipton R, Goadsby P . Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001; 358(9294):1668-75. DOI: 10.1016/S0140-6736(01)06711-3. View

Dahlof C, Saiers J . Sumatriptan injection and tablets in clinical practice: results of a survey of 707 migraineurs. Headache. 2001; 38(10):756-63. DOI: 10.1046/j.1526-4610.1998.3810756.x. View

Stark R, Dahlof C, Haughie S, Hettiarachchi J . Efficacy, safety and tolerability of oral eletriptan in the acute treatment of migraine: results of a phase III, multicentre, placebo-controlled study across three attacks. Cephalalgia. 2002; 22(1):23-32. DOI: 10.1046/j.1468-2982.2002.00300.x. View

10.

Petersen K, Birk S, Lassen L, Kruuse C, Jonassen O, Lesko L . The CGRP-antagonist, BIBN4096BS does not affect cerebral or systemic haemodynamics in healthy volunteers. Cephalalgia. 2005; 25(2):139-47. DOI: 10.1111/j.1468-2982.2004.00830.x. View

11.

Mathew N . Serotonin 1D (5-HT1D) agonists and other agents in acute migraine. Neurol Clin. 1997; 15(1):61-83. DOI: 10.1016/s0733-8619(05)70295-4. View

12.

Ho T, Ferrari M, Dodick D, Galet V, Kost J, Fan X . Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. Lancet. 2008; 372(9656):2115-23. DOI: 10.1016/S0140-6736(08)61626-8. View

13.

Tfelt-Hansen P, Teall J, Rodriguez F, Giacovazzo M, Paz J, Malbecq W . Oral rizatriptan versus oral sumatriptan: a direct comparative study in the acute treatment of migraine. Rizatriptan 030 Study Group. Headache. 2001; 38(10):748-55. DOI: 10.1046/j.1526-4610.1998.3810748.x. View

14.

. Treatment of migraine attacks with sumatriptan. N Engl J Med. 1991; 325(5):316-21. DOI: 10.1056/NEJM199108013250504. View

15.

Sheftell F, Ryan R, Pitman V . Efficacy, safety, and tolerability of oral eletriptan for treatment of acute migraine: a multicenter, double-blind, placebo-controlled study conducted in the United States. Headache. 2003; 43(3):202-13. DOI: 10.1046/j.1526-4610.2003.03043.x. View

16.

Connor K, Shapiro R, Diener H, Lucas S, Kost J, Fan X . Randomized, controlled trial of telcagepant for the acute treatment of migraine. Neurology. 2009; 73(12):970-7. PMC: 2754336. DOI: 10.1212/WNL.0b013e3181b87942. View

17.

Rapoport A, Ryan R, Goldstein J, Keywood C . Dose range-finding studies with frovatriptan in the acute treatment of migraine. Headache. 2002; 42 Suppl 2:S74-83. DOI: 10.1046/j.1526-4610.42.s2.5.x. View

18.

Goadsby P, Dodick D, Almas M, Diener H, Tfelt-Hansen P, Lipton R . Treatment-emergent CNS symptoms following triptan therapy are part of the attack. Cephalalgia. 2007; 27(3):254-62. DOI: 10.1111/j.1468-2982.2007.01278.x. View

19.

Goadsby P . New directions in migraine research. J Clin Neurosci. 2002; 9(4):368-73. DOI: 10.1054/jocn.2001.0967. View

20.

Gijsman H, Kramer M, Sargent J, Tuchman M, Matzura-Wolfe D, Polis A . Double-blind, placebo-controlled, dose-finding study of rizatriptan (MK-462) in the acute treatment of migraine. Cephalalgia. 1997; 17(6):647-51. DOI: 10.1046/j.1468-2982.1997.1706647.x. View