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Optimal balance of efficacy and tolerability of oral triptans and telcagepant: a review and a clinical comment.

Tfelt-Hansen P - J Headache Pain (2011)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Danish Headache Center, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. ptha@glo.regionh.dk

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.

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Related in: MedlinePlus

Effect of frovatriptan 0.5, 1, 2.5, 5, 10, 20, and 40 mg on headache relief and adverse events in two RCTs [19]
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Fig6: Effect of frovatriptan 0.5, 1, 2.5, 5, 10, 20, and 40 mg on headache relief and adverse events in two RCTs [19]

Mentions: For three triptans (zolmitriptan, naratriptan, and almotriptan) the balance of efficacy and tolerability could be evaluated by drawing the curves from one dose-defining study as shown in Figs. 2, 3, and 4. Two dose-defining studies [5, 6] were needed to evaluate the full dose–responses curves for sumatriptan and frovatriptan (Figs. 1, 2, and 6). For rizatriptan and eletriptan the incidence of AEs was not presented [7–11] and only the results for efficacy of these two triptans are mentioned briefly.Fig. 1


Optimal balance of efficacy and tolerability of oral triptans and telcagepant: a review and a clinical comment.

Tfelt-Hansen P - J Headache Pain (2011)

Effect of frovatriptan 0.5, 1, 2.5, 5, 10, 20, and 40 mg on headache relief and adverse events in two RCTs [19]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3094671&req=5

Fig6: Effect of frovatriptan 0.5, 1, 2.5, 5, 10, 20, and 40 mg on headache relief and adverse events in two RCTs [19]
Mentions: For three triptans (zolmitriptan, naratriptan, and almotriptan) the balance of efficacy and tolerability could be evaluated by drawing the curves from one dose-defining study as shown in Figs. 2, 3, and 4. Two dose-defining studies [5, 6] were needed to evaluate the full dose–responses curves for sumatriptan and frovatriptan (Figs. 1, 2, and 6). For rizatriptan and eletriptan the incidence of AEs was not presented [7–11] and only the results for efficacy of these two triptans are mentioned briefly.Fig. 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Danish Headache Center, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. ptha@glo.regionh.dk

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.

Show MeSH
Related in: MedlinePlus