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telcagepant

Phase 3

Migraine | Small molecule | Neurology |Merck & Company, Inc.|Last Updated: Apr 2, 2019

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindACTIVE_CONTROLLEDDMCBiomarker
Total Trials4
Total Enrollment5,986
FDA Designations
No designations recorded
Clinical Trials (4)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT00442936Study of Telcagepant (MK-0974) in Participants With Moderate to Severe Acute Migraine With or Without Aura (MK-0974-011)PHASE3 COMPLETED 1,380Feb 15, 2007Oct 2, 2007Oct 17, 2018 -
NCT01125774Telcagepant for Prevention of Menstrually Related Migraine in Female Participants With Episodic Migraine (MK-0974-065)PHASE2 COMPLETED 4,548Jun 1, 2010Apr 8, 2011Oct 23, 2018 -
NCT01315847Positron Emission Tomography (PET) Study of Brain Calcitonin Gene-Related Peptide (CGRP) Receptor Occupancy After Telcagepant Administration (MK-0974-067)PHASE1 COMPLETED 10Jan 14, 2010Jul 26, 2011Apr 2, 2019 -
NCT01209741Bioavailability of Variably Aged MK-0974 Tablets (MK-0974-038)(COMPLETED)PHASE1 COMPLETED 48Oct 1, 2007Nov 1, 2007Aug 18, 2015 -
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Study Endpoints
Primary Endpoints
Number of Participants With Pain Freedom (PF) at 2 Hours Post-Dose
2 hours post-dose

Participants were asked to rate their migraine headache severity with ratings of 0=No pain, 1=Mild pain, 2=Moderate pain, and 3=Severe pain. PF at 2 hours post-dose is defined as a decrease from a moderate or severe migraine headache (Grade 2 or 3) at baseline to no pain (Grade 0) at 2 hours post-dose.

Number of Participants With Pain Relief (PR) at 2 Hours Post-Dose
2 hours post-dose

Participants were asked to rate their migraine headache severity with ratings of 0=No pain, 1=Mild pain, 2=Moderate pain, and 3=Severe pain. PR at 2 hours post-dose is defined as a shift from a moderate or severe migraine headache (Grade 2 or 3) at baseline to mild or no pain (Grade 1 or 0) at 2 hours post-dose.

Number of Participants With Absence of Photophobia at 2 Hours Post-Dose
2 hours post-dose

Participants were asked if they experienced any sensitivity to light. The number of participants who experienced no photophobia (sensitivity to light) at 2 hours post-dose was determined.

Number of Participants With Absence of Phonophobia at 2 Hours Post-Dose
2 hours post-dose

Participants were asked if they experienced any sensitivity to sound. The number of participants who experienced no phonophobia (sensitivity to sound) at 2 hours post-dose was determined.

Number of Participants With Absence of Nausea at 2 Hours Post-Dose
2 hours post-dose

Participants were asked if they experienced any nausea. The number of participants who experienced no nausea at 2 hours post-dose was determined.

Number of Participants Who Experience At Least One Adverse Event (AE)
Up to 14 days after last dose of study drug

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the product. Participants were monitored for occurrence AEs for up to 14 days after last dose study drug. Participants who took both active and placebo study drug were counted in the active group.

Number of Participants Who Discontinue Study Drug Due to an AE
Up to 48 hours after first dose of study drug

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the product. Participants who took both active and placebo study drug were counted in the active group.

Number of Participants With Clinical Adverse Events (AEs)
Up to 14 days after the last dose of study drug (Up to 6.5 months)

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the study drug, is also an AE. A clinical AE is an AE reported as a result of a clinical examination or reported by the participant.

Number of Participants Who Discontinued Study Due to a Clinical AE
Up to 6 months

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the study drug, is also an AE. A clinical AE is an AE reported as a result of a clinical examination or reported by the participant.

Number of Participants With Laboratory AEs
Up to 6 months

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the study drug, is also an AE. A laboratory AE is an AE reported as a result of a laboratory assessment or test.

Number of Participants Who Discontinued Study Due to a Laboratory AE
Up to 6 months

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study drug, whether or not considered related to the use of the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the study drug, is also an AE. A laboratory AE is an AE reported as a result of a laboratory assessment or test.

Mean Monthly Headache Days During Entire Study Period Among Participants With Menstrually-related Migraine (MRM) or Pure Menstrual Migraine (PMM) Who Have an Average of 5 or More Moderate or Severe Migraine Headaches Per Month at Baseline
Up to 6 months

Participants completed a headache diary each evening at bedtime, including recording headache duration and acute headache medication use. Mean monthly headache days was calculated from diary data. A headache day was defined as a day in which a headache (defined as headache pain ≥30 minute duration or requiring acute treatment) started, ended, or recurred. Headache pain persisting for more than 1 calendar day after initial onset was considered an occurrence of additional headache days. Mean monthly rate was adjusted to 28 days. Participant subgroups (based on symptoms over the 3 menstrual cycles prior to study): PMM - In ≥2 out of 3 cycles attacks occur exclusively on Day 1 ± 2 of menstruation and at no other times of the cycle; MRM - In ≥2 out of 3 cycles attacks occur on Day 1 ± 2 of menstruation and additionally at other times of the cycle.

Number of Participants With Adverse Events (AEs) (Part I)
Up 14 days after the last dose of telcagepant and/or [11C]MK-4232 in Part I of study (Up to approximately 14 weeks)

Any AEs occurring among participants (all were healthy subjects) in Part I of study were recorded. An AE was defined as any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which was temporally associated with the administration of the study drug, was also an AE.

Number of Participants With AEs (Part III)
Up 14 days after the last dose of telcagepant and/or [11C]MK-4232 in Part III of study (Up to approximately 6 months)

Any AEs occurring among participants (all were migraine patients) in Part III of study were recorded. An AE was defined as any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which was temporally associated with the administration of the study drug, was also an AE.

Brain Calcitonin Gene-related Peptide (CGRP) Receptor Occupancy (RO) Post Telcagepant Obtained by PET Imaging Using [11C]MK-4232 Tracer at Baseline and After a Maximum Dose of Telcagepant (1120 mg) in Healthy Participants (Part I, Period 1)
Part I Baseline, at ~0-90 minutes after [11C]MK-4232 dose; and Part I, Period 1 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

Brain CGRP RO post telcagepant was determined by change in \[11C\]MK-4232 PET tracer biokinetics at baseline and post telcagepant administration. Using PET brain images acquired over \~0-90 minutes after \[11C\]MK-4232 dose, regions of interest (ROIs) were drawn throughout cerebral cortex and white matter, striatum, thalamus, cerebellum and pons. The ROIs were projected onto all frames of the dynamic PET scans in order to generate \[11C\]MK-4232 tissue time-activity curves (TACs). Serial arterial blood samples for measurement of plasma radioactivity and \[11C\]MK-4232 concentrations were collected during the PET scans. These samples provided the arterial input function for a two-tissue compartmental model of \[11C\]MK-4232 tracer biokinetics. Total volume of distribution (VT), an index of receptor density, was estimated by fitting the two-tissue compartmental model to the PET \[11C\]MK-4232 TACs. Change in VT between baseline and post telcagepant PET studies was used to quantify the brain CGRP RO.

Average Telcagepant Plasma Concentration During PET Imaging Using [11C]MK-4232 Tracer After a Maximum Dose of Telcagepant (1120 mg) in Healthy Participants (Part I, Period 1)
Part I, Period 1 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

In Part I, Period 1 blood samples for determination of plasma telcagepant concentrations were obtained prior to the telcagepant dose (time 0) and at 2, 3, 4 and 5 hours post telcagepant dose. The average plasma telcagepant concentration during the PET scan was determined, calculated as the area under the plasma telcagepant concentration versus time curve during the PET scanning interval divided by the duration of the PET scanning interval.

Brain CGRP RO Post Telcagepant Obtained by PET Imaging Using [11C]MK-4232 Tracer at Baseline and After a Therapeutic Dose of Telcagepant (140 mg) in Healthy Participants (Part I, Period 2)
Part I Baseline, at ~0-90 minutes after [11C]MK-4232 dose; and Part I, Period 2 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

Brain CGRP RO post telcagepant was determined by change in \[11C\]MK-4232 PET tracer biokinetics at baseline and post telcagepant administration. Using PET brain images acquired over \~0-90 miniutes after \[11C\]MK-4232 dose, ROIs were drawn throughout the cerebral cortex and white matter, striatum, thalamus, cerebellum and pons. The ROIs were projected onto all frames of the dynamic PET scans in order to generate \[11C\]MK-4232 tissue TACs. Serial arterial blood samples for measurement of plasma radioactivity and \[11C\]MK-4232 concentrations were collected during the PET scans. These samples provided the arterial input function for a two-tissue compartmental model of \[11C\]MK-4232 tracer biokinetics. VT, an index of receptor density, was estimated by fitting the two-tissue compartmental model to the PET \[11C\]MK-4232 TACs. The change in VT between the baseline and post telcagepant PET studies was used to quantify the brain CGRP RO.

Average Telcagepant Plasma Concentration During PET Imaging Using [11C]MK-4232 Tracer After a Therapeutic Dose of Telcagepant (140 mg) in Healthy Participants (Part I, Period 2)
Part 1, Period 2 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

In Part I, Period 2 blood samples for determination of plasma telcagepant concentrations were obtained prior to the telcagepant dose (time 0) and at 1, 2, 3 and 4 hours post telcagepant dose. The average plasma telcagepant concentration during the PET scan was determined, calculated as the area under the plasma telcagepant concentration versus time curve during the PET scanning interval divided by the duration of the PET scanning interval.

Brain CGRP RO Post Telcagepant Obtained by PET Imaging Using [11C]MK-4232 Tracer at Baseline and After a Therapeutic Dose of Telcagepant (140 mg) in Participants With Migraine During a Migraine Attack (Ictal Phase)(Part III, Period 1)
Part III, Period 1 Baseline, at ~0-90 minutes after [11C]MK-4232 dose; and Part III, Period 1 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

Brain CGRP RO post telcagepant was determined by change in \[11C\]MK-4232 PET tracer biokinetics at baseline and post telcagepant administration. Using PET brain images acquired over \~0-90 minutes after \[11C\]MK-4232 dose, ROIs were drawn throughout the cerebral cortex and white matter, striatum, thalamus, cerebellum and pons. The ROIs were projected onto all frames of the dynamic PET scans in order to generate \[11C\]MK-4232 tissue TACs. Serial arterial blood samples for measurement of plasma radioactivity and \[11C\]MK-4232 concentrations were collected during the PET scans. These samples provided the arterial input function for a two-tissue compartmental model of \[11C\]MK-4232 tracer biokinetics. VT, an index of receptor density, was estimated by fitting the two-tissue compartmental model to the PET \[11C\]MK-4232 TACs. The change in VT between the baseline and post telcagepant PET studies was used to quantify the brain CGRP RO.

Brain CGRP RO Post Telcagepant Obtained by PET Imaging Using [11C]MK-4232 Tracer at Baseline and After a Therapeutic Dose of Telcagepant (140 mg) in Participants With Migraine During Period When Migraine is Absent (Interictal Phase)(Part III, Period 2)
Part III, Period 2 Baseline, at ~0-90 minutes after [11C]MK-4232 dose; and Part III, Period 2 post telcagepant, at ~0-90 minutes after [11C]MK-4232 dose

Brain CGRP RO post telcagepant was determined by change in \[11C\]MK-4232 PET tracer biokinetics at baseline and post telcagepant administration. Using PET brain images acquired over \~0-90 minutes after \[11C\]MK-4232 dose, ROIs were drawn throughout the cerebral cortex and white matter, striatum, thalamus, cerebellum and pons. The ROIs were projected onto all frames of the dynamic PET scans in order to generate \[11C\]MK-4232 tissue TACs. Serial arterial blood samples for measurement of plasma radioactivity and \[11C\]MK-4232 concentrations were collected during the PET scans. These samples provided the arterial input function for a two-tissue compartmental model of \[11C\]MK-4232 tracer biokinetics. VT, an index of receptor density, was estimated by fitting the two-tissue compartmental model to the PET \[11C\]MK-4232 TACs. The change in VT between the baseline and post telcagepant PET studies was used to quantify the brain CGRP RO.

Area under the curve (AUC(0 to infinity) following single dose administration of MK-0974 12Mo5C and 5Mo5C formulations
Through 48 hours postdose
Peak plasma concentration (Cmax) following single dose administration of MK-0974 12Mo5C and 5Mo5C formulations
Through 48 hours postdose
Secondary Endpoints
Number of Participants With Sustained Pain Freedom (SPF) From 2 to 24 Hours Post-Dose
2 to 24 hours post-dose
Number of Participants With Total Migraine Freedom (TMF) at 2 Hours Post-Dose
2 hours post-dose
Number of Participants With Total Migraine Freedom (TMF) at 2 to 24 Hours Post-Dose
2 to 24 hours post-dose
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Telcagepant 150 mgEXPERIMENTALParticipants receive telcagepant 150 mg capsules, one capsule administered orally at initial onset of moderate to severe migraine headache. If, after 2 hours post-dose, participants still have a moderate to severe migraine or migraine recurs, participants may receive an optional second dose of study drug (telcagepant 150 mg or placebo) or one dose of non-study rescue medication.
Telcagepant 300 mgEXPERIMENTALParticipants receive telcagepant 300 mg capsules, one capsule administered orally at initial onset of moderate to severe migraine headache. If, after 2 hours post-dose, participants still have a moderate to severe migraine or migraine recurs, participants may receive an optional second dose of study drug (telcagepant 300 mg or placebo) or one dose of non-study rescue medication.
Zolmitriptan 5 mgACTIVE_COMPARATORParticipants receive zolmitriptan 5 mg tablets, one tablet administered orally at initial onset of moderate to severe migraine headache. If, after 2 hours post-dose, participants still have a moderate to severe migraine or migraine recurs, participants may receive an optional second dose of study drug (placebo) or one dose of non-study rescue medication.
PlaceboPLACEBO_COMPARATORParticipants receive placebo matching capsules or tablets, one capsule or tablet administered orally at initial onset of moderate to severe migraine headache. If, after 2 hours post-dose, participants still have a moderate to severe migraine or migraine recurs, participants may receive an optional second dose of study drug (placebo) or one dose of non-study rescue medication.
TelcagepantEXPERIMENTALTelcagepant 140 mg was administered once daily at bedtime for 7 consecutive days each month, beginning at the onset of menses, for up to 6 months. Dosing could begin up to 3 days prior to menses onset if prodromal symptoms reliably predicted onset of menses.
Healthy Participants (Part I)EXPERIMENTALBaseline PET imaging of the brain using \[11C\]MK-4232 tracer (\~300 megabecquerel \[MBq\]) was performed in healthy participants; this PET data served as the baseline for both Period 1 and 2 of Part I. Subsequently in study Part I, Period 1 the healthy participants received a single 1120 mg dose of telcagepant followed by PET imaging of brain with \[11C\]MK-4232 tracer (\~300 MBq) beginning \~3 hours post telcagepant dose. In Part I, Period 2 the healthy participants received a single 140 mg dose of telcagepant followed by PET imaging of brain with \[11C\]MK-4232 tracer (\~300 MBq) beginning \~2 hours post telcagepant dose. Interval between Part I Period 1 and 2 was to be at least 1 week.
Participants with Migraine (Part III)EXPERIMENTALIn study Part III, Period 1 baseline PET imaging of the brain using \[11C\]MK-4232 tracer (\~300 MBq) was performed in participants with migraine during a migraine attack (ictal phase). Later in Part III, Period 1 the participants with an ongoing migraine attack (ictal phase) received a single 140 mg dose of telcagepant followed by PET imaging of brain with \[11C\]MK-4232 tracer (\~300 MBq) beginning \~2 hours post telcagepant dose. In Part III, Period 2 baseline PET imaging of the brain using \[11C\]MK-4232 tracer (\~300 MBq) was performed in participants with migraine, however, without a migraine attack ongoing (interictal phase). Later in Part III, Period 2 participants with migraine without a migraine attack ongoing (interictal phase) received a single 140 mg dose of telcagepant followed by PET imaging of brain with \[11C\]MK-4232 tracer (\~300 MBq) beginning \~2 hours post telcagepant dose. Interval between Part III Period 1 and 2 was to be at least 1 week.
1ACTIVE_COMPARATORMK-0974 12MoRT
2ACTIVE_COMPARATORMK-0974 5Mo5C
3ACTIVE_COMPARATORMK-0974 12Mo5C
Interventions
NameTypeDescription
Telcagepant potassium 150 mgDRUGTelcagepant 150 mg liquid-filled soft gel capsules
Telcagepant potassium 300 mgDRUGTelcagepant 300 mg liquid-filled soft gel capsules
Zolmitriptan 5 mgDRUGZolmitriptan 5 mg tablets
Placebo to telcagepant 150 mgDRUGPlacebo to match telcagepant 150 mg liquid-filled soft gel capsules
Placebo to tecagepant 300 mgDRUGPlacebo to match tecagepant 300 mg liquid-filled soft gel capsules
Placebo to zolmitriptan 5 mgDRUGPlacebo to match zolmitriptan 5 mg tablets
Rescue medicationDRUGIf moderate or severe migraine headache pain continues or recurs 2 hours after dose of study drug, participants are allowed to take an optional second dose of study drug or their own non-study rescue migraine medication, which may include analgesics (e.g., nonsteroidal anti-inflammatory drugs \[NSAIDs\] or opiates), anti-emetics, or zolmitriptan. Triptans other than zolmitriptan and ergot derivatives are prohibited for 24 hours following the last dose of study drug.
TelcagepantDRUGTelcagepant 140 mg film coated tablet for oral administration
PlaceboDRUGPlacebo to match telcagepant 140 mg film coated tablet for oral administration
[11C]MK-4232DRUGSingle intravenous doses of \~300 MBq \[11C\]MK-4232 administered as a 5 minute infusion (Part I - Baseline, Period 1 and 2; Part III - Period 1 Baseline and Period 1, and Period 2 Baseline and Period 2)
telcagepant potassiumDRUG\[INTERVENTION NAME: MK-0974 12MoRT\] Single dose MK-0974 12MoRT (12 month aged MK-0974 capsules, stored at room temperature) 300 mg in one of three treatment periods
MK-0974 5Mo5CDRUGSingle dose MK-0974 5Mo5C (5 month aged MK-0974 capsules, stored at 5 °C) 300 mg in one of three treatment periods
MK-0974 12Mo5CDRUGSingle dose MK-0974 12Mo5C (12 month aged MK-0974 capsules, stored at 5 °C) 300 mg in one of three treatment periods
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Eligibility Criteria
Age Range18 Years — N/A
SexALL
Healthy VolunteersNo

Inclusion Criteria: * Has at least 1 year history of migraine (with or without aura) * Females of child bearing potential must use acceptable contraception throughout trial. Exclusion Criteria: * Is pregnant/breast-feeding (or is a female expecting to conceive during study period) * Has history o...

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