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To the Editor:
Connor et al.1 report that the use of 150 mg of telcagepant results in pain relief at 2 hours in 54% of patients with migraine compared to 33% of patients achieving this endpoint with placebo. Merck Research Laboratories funded this study and all the authors were employees of Merck or had financial ties to Merck or other large pharmaceutical companies. The publication of this trial raises serious concerns.
Triptans are the standard care for moderate to severe migraine. Sumatriptan 50 mg, now available as a generic, results in pain relief at 2 hours in 50% to 59% of patients with migraine compared to 17% to 26% for placebo.2 The relevant question for patients and physicians is whether telcagepant offers any advantage over sumatriptan.
The authors justify comparing telcagepant to placebo—rather than to active treatment— because it may be used in patients with coronary artery or cerebrovascular disease, in whom triptans are contraindicated. However, if this is the population of interest for telcagepant, it should be tested in this population.
There are sufficient preliminary data supporting the superiority of telcagepant to placebo. A placebo-controlled trial in the population of patients eligible for triptan treatment before a trial in the clinically …
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