Merck Research Laboratories, North Wales, PA 19454-1099, USA.
Headache. 2011 Jan;51(1):64-72. doi: 10.1111/j.1526-4610.2010.01790.x. Epub 2010 Nov 4.
To evaluate whether the same or different patients respond to triptans and telcagepant.
Telcagepant is an oral calcitonin gene-related peptide receptor antagonist with acute antimigraine efficacy comparable to oral triptans. It is currently unknown whether migraine patients who cannot be adequately helped with triptans might benefit from treatment with telcagepant.
Post-hoc analysis of data from a randomized, controlled trial of telcagepant (150 mg, 300 mg) zolmitriptan 5 mg, or placebo for a moderate/severe migraine. Responder rates were analyzed according to patients' self-reported historical triptan response (HTR): (1) good HTR (N = 660): response in 75-100% of attacks; (2) intermediate HTR (N = 248): response in 25-74% of attacks; (3) poor HTR/no use (N = 407): response in < 25% of attacks, or patient did not take triptans. A limitation of the analysis is that the last subgroup comprised mainly (91%) patients who reported that they did not take triptans, but it was not known whether these patients were triptan-naïve or had previously used triptans and stopped taking them.
For zolmitriptan, 2-hour pain relief rates were higher in the good HTR subgroup (116/162, 72%) than in the intermediate (29/62, 47%) and poor/no use (44/111, 40%) HTR subgroups. The 2-hour pain relief rates were similar across HTR subgroups for telcagepant 150 mg (48-58%), 300 mg (52-58%), and placebo (26-31%). In the poor/no use HTR subgroup, more patients receiving telcagepant 300 mg (56/98, 57.1%) had 2-hour pain relief than those receiving zolmitriptan (44/111, 39.6%; odds ratio = 2.11 [95% CI: 1.20,3.71], P = .009); the percentage for telcagepant 150 mg (57/119, 47.9%) was not significantly different from zolmitriptan (odds ratio = 1.41 [95% CI: 0.82, 2.40], P = .211).
This suggests that different patients may respond to triptans or telcagepant 300 mg. Caution should be exercised in interpreting the results because of the post-hoc nature of the analysis (clinical trial registry: NCT00442936).
评估相同或不同的患者对曲普坦类药物和替拉那班的反应。
替拉那班是一种口服降钙素基因相关肽受体拮抗剂，其急性抗偏头痛疗效与口服曲普坦类药物相当。目前尚不清楚不能充分受益于曲普坦类药物治疗的偏头痛患者是否可能从替拉那班治疗中获益。
替拉那班（150mg、300mg）、佐米曲普坦 5mg 或安慰剂治疗中度/重度偏头痛的随机对照试验的事后分析。根据患者自我报告的曲普坦类药物既往反应（HTR），分析应答率：（1）良好 HTR（N=660）：反应率为 75-100%；（2）中等 HTR（N=248）：反应率为 25-74%；（3）差 HTR/未使用（N=407）：反应率<25%，或患者未服用曲普坦类药物。该分析的一个局限性是，最后一个亚组主要包括（91%）报告未服用曲普坦类药物的患者，但尚不清楚这些患者是否为曲普坦类药物初治患者，或是否曾使用过曲普坦类药物但已停止使用。
佐米曲普坦组 2 小时疼痛缓解率在良好 HTR 亚组（116/162，72%）高于中等 HTR（29/62，47%）和差/未使用 HTR（44/111，40%）亚组。替拉那班 150mg、300mg 和安慰剂组的 2 小时疼痛缓解率在 HTR 亚组之间相似（48-58%）。在差/未使用 HTR 亚组中，接受替拉那班 300mg 治疗的患者（56/98，57.1%）比接受佐米曲普坦治疗的患者（44/111，39.6%；优势比=2.11[95%CI：1.20，3.71]，P=0.009）的 2 小时疼痛缓解率更高；替拉那班 150mg 组（57/119，47.9%）与佐米曲普坦组的比例无显著差异（优势比=1.41[95%CI：0.82，2.40]，P=0.211）。
这表明不同的患者可能对曲普坦类药物或替拉那班 300mg 有反应。由于分析的事后性质（临床试验注册：NCT00442936），应谨慎解释结果。
