The Cost-Effectiveness of Pregabalin Versus Gabapentin for Peripheral Neuropathic Pain (pNeP) and Postherpetic Neuralgia (PHN) in China

Comparison of the efficacy of pulsed radiofrequency in treating acute herpetic neuralgia and postherpetic neuralgia in the thoracic segment

Objectives

This study aimed to compare the efficacy of pulsed radiofrequency (PRF) to dorsal root ganglia (DRG) in treating acute herpetic neuralgia (AHN) and postherpetic neuralgia (PHN) in the thoracic segment.

Methods

A total of 243 patients with thoracic herpes zoster-related pain (AHN or PHN) from January 2020 to September 2022 were retrospectively analyzed. They were divided into two groups based on the timing of PRF after herpes zoster onset: an acute herpetic neuralgia group (within 90 days) and a postherpetic neuralgia group (more than 90 days). All patients were treated with PRF at the thoracic DRG. The Visual Analog Scale (VAS), the Athens Insomnia Scale (AIS), the Generalized Anxiety Disorder-7 items (GAD-7), and the Patient Health Questionnaire-9 items (PHQ-9) scores were assessed before and at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, and the results were then compared between the two groups.

Results

Postoperative scores of VAS, AIS, GAD-7, and PHQ-9 in both groups were significantly lower than preoperative scores (P < 0.001). From 1 month to 12 months after surgery, the AHN group showed significantly lower VAS, AIS, GAD-7, and PHQ-9 scores compared to the PHN group (P < 0.001). In the AHN group, there was a gradual improvement in these scores from 1 week to 12 months post-surgery. Conversely, the PHN group's scores began to worsen slowly from 1 week to 12 months post-surgery. Over time, the difference in scores between the two groups also increased gradually.

Conclusion

PRF to the DRG is an effective treatment for patients with AHN or PHN who do not respond well to conventional treatments. For AHN patients, PRF to the DRG significantly enhances early pain control, improves sleep and psychological status, and may even prevent the development of PHN.

Correlation between spinal cord stimulation analgesia and cortical dynamics in pain management

AIM

Spinal cord stimulation (SCS) is an effective method to treat neuropathic pain. It is necessary to identify the responders of SCS analgesia before implantation. The aim of this study is to investigate the relationship between the cortical dynamics and SCS analgesia responders in pain management.

METHODS

Resting-state EEG recording was performed in patients who underwent short-term implantation of spinal cord stimulation for pain therapy. We then did spectral analysis to capture the pattern of cortical oscillation between neuromodulation therapy analgesia responders and nonresponders.

RESULTS

About 58.3% (14 out of 24) of participants were considered as analgesia responders, with average visual analogue scores reduction of 4.8 ± 1.0 after surgery, and 2.1 ± 0.7 for the nonresponder subgroup, respectively. The alpha oscillation was significantly enhanced in responder cohort compared with nonresponders. We also observed an increasing spectral power of gamma band in responders. Furthermore, the attenuation of pain severity was significantly correlated with the global alpha oscillation activity (r = 0.60, P = 0.002). Likely, positive and significant correlation was found between the pain relief and gamma activity (r = 0.58, P = 0.003).

CONCLUSIONS

Distinct pattern of neural oscillation is associated with the analgesic effect of spinal cord stimulation in pain management, enhancement of cortical alpha and gamma oscillation may be a predictor of analgesia responders.

Gabapentinoid consumption in 65 countries and regions from 2008 to 2018: a longitudinal trend study

Recent studies raised concerns about the increasing use of gabapentinoids in different countries. With their potential for misuse and addiction, understanding the global consumption of gabapentinoids will offer us a platform to examine the need for any interventional policies. This longitudinal trend study utilised pharmaceutical sales data from 65 countries and regions across the world to evaluate the global trends in gabapentinoid consumption between 2008-2018. The multinational average annual percentage change of gabapentinoid consumption was +17.20%, increased from 4.17 defined daily dose per ten thousand inhabitants per day (DDD/TID) in 2008 to 18.26 DDD/TID in 2018. High-income countries had the highest pooled gabapentinoid consumption rate (39.92 DDD/TID) in 2018, which was more than six times higher than the lower-middle income countries (6.11 DDD/TID). The study shows that despite differences in healthcare system and culture, a consistent increase in gabapentinoid consumption is observed worldwide, with high-income countries remaining the largest consumers.

A Meta-analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Pregabalin and Gabapentin in the Treatment of Postherpetic Neuralgia

OBJECTIVE

To systematically evaluate the clinical efficacy of pregabalin and gabapentin in the treatment of postherpetic neuralgia (PHN), including the difference in pain control and occurrence of adverse reactions.

METHODS

PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) comparing the efficacy of pregabalin and gabapentin in patients with PHN. Data from studies meeting the inclusion criteria were extracted and the Cochrane Risk of Bias risk assessment tool was used to evaluate the quality of the included studies. Revman 5.3 and Stata17 were used to perform the meta-analysis and to detect publication bias.

RESULTS

A total of 14 RCTs with 3545 patients were included in this study, including 926 in the pregabalin treatment group, 1256 in the gabapentin treatment group, and 1363 in the placebo control group. Pregabalin was better than gabapentin in alleviating pain and improving the global perception of change in pain and sleep (P < 0.05). Gabapentin was associated with a lower incidence of adverse events than pregabalin (P < 0.05). Funnel plot and Begg's and Egger's tests showed no significant publication bias.

CONCLUSION

Pregabalin appears to have a better overall therapeutic effect than gabapentin for patients with PHN, but gabapentin has a lower incidence of adverse reactions and a better safety profile. Clinicians should comprehensively consider patient factors and fully evaluate the advantages and disadvantages of each treatment option to select the most suitable drugs for patient use. Considering the limited quantity and quality of the existing literature, high-quality RCTs are needed to confirm the advantages of pregabalin over gabapentin in the treatment of PHN and guide clinical decision-making.

Current state of the red scrotum syndrome

Red scrotum syndrome is a chronic, difficult-to-recognize dermatosis affecting middle-aged and elderly people. It is manifested by erythema of the scrotum with clear boundaries, without neck. The etiology and pathogenesis of the disease have not been established. Hypotheses about the causes of dermatosis as a consequence of uncontrolled use of topical steroids, neurological inflammation, formation of microbial biofilm are based on anamnestic data and the results of trial treatments. Etiologically and pathogenetically justified therapy has not been proposed. Therapy with the use of doxycycline, gabapentin, pregabalin, indomethacin, tacrolimus was carried out in small groups of patients. The lack of clarity in the etiology and understanding of the mechanism of development of the disease explains the lack of a unified focus of the proposed therapies based on isolated clinical cases. In general, the problem of diagnosis and treatment rests on the absence of major clinical, epidemiological and laboratory studies that allowed to establish the pathophysiology and assess the true prevalence of red scrotum syndrome.

Cost-utility analysis of transcranial direct current stimulation therapy with and without virtual illusion for neuropathic pain for adults with spinal cord injury in Canada

OBJECTIVE

To undertake a cost-utility analysis comparing virtual illusion (VI) and transcranial direct current stimulation (tDCS) combination therapy, tDCS alone and standard pharmacological care in Ontario, Canada from a societal perspective over a three-month time horizon.

DESIGN

Cost-utility analysis using Markov model methods.

SETTING

Community setting in Ontario, Canada.

PARTICIPANTS

Individuals with spinal cord injury and neuropathic pain (NP) resistant to pharmacological therapy.

INTERVENTIONS

Virtual illusion and transcranial direct current stimulation, transcranial direct current stimulation alone and standard pharmacological therapy.

OUTCOME MEASURES

Incremental costs, quality adjusted life years (QALY) and incremental cost effectiveness ratio.

RESULTS

The incremental cost effectiveness ratio of VI and tDCS therapy cost is $3,396 per QALY (2020 Canadian dollars) when compared to standard care. The incremental cost per QALY of tDCS therapy alone is $33,167. VI and tDCS therapy had lower incremental costs (-$519) and higher incremental QALYs (0.026) compared to tDCS alone. From a public healthcare payer perspective, there is a 74% probability that VI and tDCS therapy and 54% probability that tDCS alone would be cost effective at a $50,000 per QALY willingness-to-pay threshold. Our findings remained relatively robust in various scenario analyses.

CONCLUSION

Our findings suggest that at three-months after therapy, VI and tDCS combination therapy may be more cost effective than tDCS therapy alone. Based on conventional health technology funding thresholds, VI and tDCS combination therapy merits consideration for the treatment of NP in adults with spinal cord injuries.

Red Scrotum Syndrome Treatment with Pregabalin: A Case Series

Red scrotum syndrome (RSS) (also known as male genital dysesthesia) is a rarely recognized entity characterized by scrotal erythema accompanied by a burning sensation, pain, hyperesthesia/dysesthesia, increased temperature and pruritus. Although its physiopathology is unknown, it has increasingly been associated with chronic topical steroid use in the male genital area. Treatment is challenging and no standardized treatment is currently available. Because current treatment relies on case reports and small case series, the need for more information about drug efficacy in RSS is warranted. The aim of this study is to describe the therapeutic response to pregabalin in patients from an outpatient dermatologic clinic in a tertiary-care hospital diagnosed with RSS. Five patients with a confirmed diagnosis of RSS were included. Ages ranged from 28 to 63 years. All patients had chronic steroid use in the genital area, mostly in the form of combined formulations of corticosteroids, antifungals, and antibiotics. Four patients were prescribed pregabalin monotherapy, 150 mg once daily at night. One patient was prescribed pregabalin and doxycycline. Two patients had complete remission after one month of therapy, one at two months and two at three months. None experienced recurrence at an average of 9.4 months' follow-up. One patient experienced morning drowsiness that did not require suspending treatment. Pregabalin is a well-tolerated and effective treatment for RSS.

Epidemiology, treatment and prevention of herpes zoster: A comprehensive review

Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.

Pharmacoeconomic Analysis of Antiepileptic Reimbursement for Neuropathic Pain in Bosnia and Herzegovina - Budget Impact Analysis of Pregabalin

Introduction:

Neuropathic pain resulting from injury to the nervous system. Up to 7% to 8% of the European population is affected. A number of different treatments for neuropathic pain have been studied including antiepileptic. Pregabalin and gabapentin are often considered first-line treatments. Pregabalin provides equivalent efficacy to gabapentin, showing greater potency at much lower doses and is considered as cost-effective intervention. In Federation of Bosnia and Herzegovina (FB&H), gabapentin is fully reimbursed, while pregabalin is enlisted on list B with copayment.

Aim:

To develop simple budget impact (BI) model and assess BI of introducing pregabalin into full reimbursement in FB&H.

Material and methods:

Budget impact model was developed using Microsoft Excel 2010. Local epidemiology data and data on drug consumption from government reports in 2016 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with pregabalin reimbursed at the same level as gabapentin. Two developed scenarios have been compared from health insurance fund (HIF) perspective.

Results:

In scenario 1 consider both drugs fully reimbursement and without patient switch among alternatives the total cost would be increased for 780,025 KM; 852,027 KM and 943,830 KM over a 3-year period. In scenario 2 considering both drugs fully reimbursed but with patient switch topregabalin total annual cost would be increased for 732,241 KM; 742,395 KM and 751,761 KM. Comparing scenario 1 and 2 it is found that scenario 2 is more favorable from HIF perspective.

Conclusion:

Implementation of pharmacoeconomic principles in reimbursement decisions in Bosnia and Herzegovina would improve access to medicines and contribute rationale resource consumption.

Cost of treating peripheral neuropathic pain with pregabalin or gabapentin at therapeutic doses in routine practice

AIM

To analyze the cost of peripheral neuropathic pain (PNP) treatment with pregabalin or gabapentin at therapeutic doses in routine clinical practice.

METHODS

Analysis of a retrospective, observational study of electronic medical records of patients treated for PNP with therapeutic doses of pregabalin or gabapentin, with 2 years' follow-up, considering PNP type, comorbidities, concomitant analgesia and resource use.

RESULTS

The weighted total average cost/patient was lower for pregabalin than gabapentin (€2464 [2197-2730] vs €3142 [2670-3614]; p = 0.014) due to significantly lower both healthcare and non-healthcare costs. This is explained by a significantly lower use of concomitant analgesia, fewer primary care visits and fewer days of sick leave.

CONCLUSION

At therapeutic doses, pregabalin was found to have lower healthcare and non-healthcare costs than gabapentin in routine practice.

The efficacy of pregabalin for acute pain control in herpetic neuralgia patients: A meta-analysis

OBJECTIVE

This meta-analysis aimed to illustrate the efficacy and safety of preganalin for pain management in patients with postherpetic neuralgia (PHN).

METHODS

In July 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients with PHN that compared pregabalin versus placebo were retrieved. The endpoints were the visual analog scale (VAS) at 8 weeks, the percentage of 30% and 50% pain responders; sleep interference score and improvement in patient global impression of change (PGIC). After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.

RESULTS

Seven clinical studies with 2192 patients (pregabalin group = 1381, control group = 811) were finally included in the meta-analysis. Pregabalin was associated with reduced pain scores at 8 weeks, corresponding to a reduction of 11.23 points (95% CI, -14.33, -8.13, P = .000) on a 100-point VAS. Pregabalin was also associated with a more percentage of 30% and 50% pain responders than controls (P < .05). Meanwhile, pregabalin can decrease sleep interference score and improvement in PGIC than control groups (P < .05).

CONCLUSIONS

Pregabalin was efficacious in the reduction of postoperative pain and improvement the sleep quality in patients with PHN.