OBJECTIVE: To evaluate whether the same or different patients respond to 
triptans and telcagepant.
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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).