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Maleki MS, Zamani Z, Amiri R, Kakhki S, Jafari M, Amani B, Amani B, Amanat N. Pregabalin in patients with post-traumatic peripheral neuropathic pain: A meta-analysis of randomized controlled trials. Pain Pract 2023. [PMID: 36912703 DOI: 10.1111/papr.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/19/2023] [Accepted: 02/17/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the safety and efficacy of pregabalin versus placebo in post-traumatic peripheral neuropathic pain (PTNP). METHODS PubMed, Cochrane Library, Web of Science, and Google Scholar were searched for relevant evidence up to January 2022. The Cochran tool was used to assess the quality of randomized clinical trials (RCTs). Data analysis was performed using Comprehensive Meta-Analysis software. RESULTS Three RCTs involving 821 patients were included in the meta-analysis. A significant difference was observed between pregabalin and placebo in terms of the pain score (the standardized mean difference [SMD] = -0.14, 95% CI: 0.28 to -0.006, p = 0.04) and sleep interference (MD = -0.25, 95% CI: -0.39 to -0.11, p = 0.00). There was also a significant difference between pregabalin and placebo regarding somnolence (risk ratio [RR] = 2.78; 95% CI: 1.64-4.71, p = 0.00), dizziness (RR = 4.13; 95% CI: 2.71-6.28, p = 0.00), and disturbance in attention (RR: 2.97; 95% CI: 1.02-8.65, p = 0.04). However, no significant difference was observed between pregabalin and placebo in terms of headache (RR = 1.20; 95% CI: 0.70-2.06, p = 0.50), fatigue (RR = 1.42; 95% CI: 0.82-2.47, p = 0.20), nausea (RR = 1.52; 95% CI: 0.88-2.62, p = 0.13), constipation (RR = 1.84; 95% CI: 0.78-4.29, p = 0.15), and discontinuation (RR = 1.52; 95% CI: 0.45-5.06, p = 0.49). CONCLUSION Compared with placebo, pregabalin showed better efficacy in reducing PTNP and improving sleep interference. However, it was associated with higher adverse events. Further RCTs are needed to confirm these findings.
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Affiliation(s)
| | - Zahra Zamani
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Roya Amiri
- Department of Intensive Care Nursing, Kish Specialty & Subspecialty Hospital, Kish, Iran
| | - Samaneh Kakhki
- Department of Clinical Biochemistry, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mojtaba Jafari
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasir Amanat
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Kwong PPK, Chan EYK, Cheung EYW, Fong SYY, Nip W, Cheung HHK, Yip IPL, Chong KY, Pao RSY, Tam KL, Tang MH, Chan SKC, Mak KY. Consensus statements on the clinical uses of pregabalin for Hong Kong. Asia Pac Psychiatry 2020; 12:e12403. [PMID: 32830438 DOI: 10.1111/appy.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
To facilitate the understanding of pregabalin and optimize its clinical usage in Hong Kong, an expert panel (11 psychiatrists, one family physician and one anesthesiologist) experienced in treating anxiety and somatic symptoms was invited to establish a set of consensus statements based on several discussion areas. A non-systematic literature search for relevant articles was conducted. The panelists addressed the discussion areas by sharing their clinical experience and available literature in a couple of meetings. At the last meeting, consensus statements derived from the proceedings were discussed and finalized. A total of 11 statements were ultimately accepted by panel voting based on their practicability of recommendation in Hong Kong. These statements are aimed to act as a practical reference for local clinicians when they consider prescribing pregabalin in different clinical situations.
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Affiliation(s)
- Patrick Po-Keung Kwong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yan-Kwong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yat-Wo Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Samson Yat-Yuk Fong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Wai Nip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Henry Hon-Kee Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Isaac Pui-Lam Yip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - King-Yee Chong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ronnie Sze-Yuan Pao
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ka-Lok Tam
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Man-Ho Tang
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Simon Kin-Cheong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ki-Yan Mak
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
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Parsons B, Freynhagen R, Schug S, Whalen E, Ortiz M, Bhadra Brown P, Knapp L. The relationship between the reporting of euphoria events and early treatment responses to pregabalin: an exploratory post-hoc analysis. J Pain Res 2019; 12:2577-2587. [PMID: 31686899 PMCID: PMC6709807 DOI: 10.2147/jpr.s199203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Euphoria is a complex, multifactorial problem that is reported as an adverse event in clinical trials of analgesics including pregabalin. The relationship between the reporting of euphoria events and pregabalin early treatment responses was examined in this exploratory post-hoc analysis. Methods Data were from patients with neuropathic or non-neuropathic chronic pain enrolled in 40 randomized clinical trials, who received pregabalin (75–600 mg/day) or placebo. Reports of treatment-emergent euphoria events were based on the Medical Dictionary of Regulatory Activities preferred term “euphoric mood”. Prevalence rates of euphoria events overall and by indication were assessed. Post-treatment endpoints included ≥30% improvements in pain and sleep scores up to 3 weeks as well as a ≥1-point improvement in daily pain score up to 11 days after treatment. Results 13,252 patients were analyzed; 8,501 (64.1%) and 4,751 (35.9%) received pregabalin and placebo, respectively. Overall, 1.7% (n=222) of patients reported euphoria events. Among pregabalin-treated patients, a larger proportion who reported euphoria events achieved an early pain response compared with those who did not report euphoria (30% pain responders in week 1 with euphoria events [43.0%], without euphoria events [24.2%]). Results were similar for weeks 2 and 3. For Days 2–11, a larger proportion of pregabalin-treated patients with (relative to without) euphoria events were 1-point pain responders. Findings were similar in pregabalin-treated patients for sleep endpoints (30% sleep responders in week 1 with euphoria events [50.7%], without euphoria events [36.1%]). Similar results were found for weeks 2 and 3. Patients who received placebo showed similar patterns, although the overall number of them who reported euphoria events was small (n=13). Conclusion In patients who received pregabalin for neuropathic or non-neuropathic chronic pain, those who experienced euphoria events may have better early treatment responses than those who did not report euphoria events.
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Affiliation(s)
| | - Rainer Freynhagen
- Department of Anesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital, Tutzing, Germany.,Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephan Schug
- Discipline of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia
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Taguchi T, Nozawa K, Parsons B, Yoshiyama T, Ebata N, Igarashi A, Fujii K. Effectiveness of pregabalin for treatment of chronic cervical radiculopathy with upper limb radiating pain: an 8-week, multicenter prospective observational study in Japanese primary care settings. J Pain Res 2019; 12:1411-1424. [PMID: 31118759 PMCID: PMC6506009 DOI: 10.2147/jpr.s191906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Despite high prevalence of chronic neck pain in Japan and the negative impact pain has on patient’s quality of life (QoL), the therapeutic value of pregabalin for chronic neck pain with a neuropathic pain (NeP) component has not been assessed in a typical Japanese health care setting. Methods: An 8-week, non-interventional, multicenter, observational study of Japanese adults (≥20 years) with chronic refractory cervical pain including a NeP element (for ≥12 weeks) and sleep disturbance on the Pain-Related Sleep-Interference Scale (PRSIS) ≥1 (from 0 “does not interfere with sleep” to 10 “completely interferes”). Patients received either usual care with conventional analgesics or pregabalin (150–600 mg/day) for 8 weeks. “Usual care” with analgesics or other treatment(s) was determined based on physician’s best clinical judgment. Primary endpoint was change from baseline to week 8 in PRSIS. Secondary endpoints included: change from baseline to week 4 in PRSIS, and to week 4 and 8 in pain Numerical Rating Scale (NRS; from 0 “no pain” to 10 “worst possible pain”), and on the Neck Disability Index (NDI). Other assessments of QoL were undertaken. Safety was monitored. Results: Overall, 369 patients received pregabalin (n=145) or usual care (n=224). The median (range) dose of pregabalin was 49.6 (25.0–251.5) mg/day. Least-squares mean change in PRSIS from baseline to week 8 favored pregabalin (–1.167 vs –0.269; treatment difference –0.898 [95% CI –1.262, –0.535], P<0.001). Similar observations were seen at week 4 in favor of pregabalin versus usual care (P<0.001). Pregabalin significantly improved pain NRS and NDI scores at weeks 4 and 8 (all P<0.001). Improvements in QoL versus usual care were also observed. Pregabalin was generally well tolerated. Conclusion: In this open-label study, pregabalin improved PRSIS and resulted in clinically meaningful reductions in pain in Japanese patients with NeP associated with chronic cervical pain. ClinicalTrials.gov identifier: NCT02868359.
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Affiliation(s)
- Toshihiko Taguchi
- Japan Organization of Occupational Health and Safety, Yamaguchi Rosai Hospital, Sanyo-Onoda, Yamaguchi, Japan
| | | | - Bruce Parsons
- Global Medical Product Evaluation, Pfizer Inc, New York, NY, USA
| | - Tamotsu Yoshiyama
- Biometrics and Data Management, Development Japan, Pfizer R&D Japan G.K., Tokyo, Japan
| | | | - Ataru Igarashi
- Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Predicting Responses to Pregabalin for Painful Diabetic Peripheral Neuropathy Based on Trajectory-Focused Patient Profiles Derived from the First 4 Weeks of Treatment. Adv Ther 2018; 35:1585-1597. [PMID: 30206821 PMCID: PMC6182642 DOI: 10.1007/s12325-018-0780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 11/23/2022]
Abstract
Introduction Prediction of final clinical outcomes based on early weeks of treatment can enable more effective patient care for chronic pain. Our goal was to predict, with at least 90% accuracy, 12- to 13-week outcomes for pregabalin-treated painful diabetic peripheral neuropathy (pDPN) patients based on 4 weeks of pain and pain-related sleep interference data. Methods We utilized active treatment data from six placebo-controlled randomized controlled trials (n = 939) designed to evaluate efficacy of pregabalin for reducing pain in patients with pDPN. We implemented a three-step, trajectory-focused analytics approach based upon patient responses collected during the first 4 weeks using monotonicity, path length, frequency domain (FD), and k-nearest neighbor (kNN) methods. The first two steps were based on combinations of baseline pain, pain at 4 weeks, weekly monotonicity and path length during the first 4 weeks, and assignment of patients to one of four responder groups (based on presence/absence of 50% or 30% reduction from baseline pain at 4 and at 12/13 weeks). The third step included agreement between prediction of logistic regression of daily FD amplitudes and assignment made from kNN analyses. Results Step 1 correctly assigned 520/939 patients from the six studies to a responder group using a 3-metric combination approach based on unique assignment to a 50% responder group. Step 2 (applied to the remaining 419 patients) predicted an additional 121 patients, using a blend of 50% and 30% responder thresholds. Step 3 (using a combination of FD and kNN analyses) predicted 204 of the remaining 298 patients using the 50% responder threshold. Our approach correctly predicted 90.0% of all patients. Conclusion By correctly predicting 12- to 13-week responder outcomes with 90% accuracy based on responses from the first month of treatment, we demonstrated the value of trajectory measures in predicting pDPN patient response to pregabalin. Trial Registration www.clinicaltrials.gov identifiers, NCT00156078/NCT00159679/NCT00143156/NCT00553475. Funding Pfizer. Plain Language Summary Plain language summary available for this article. Electronic supplementary material The online version of this article (10.1007/s12325-018-0780-3) contains supplementary material, which is available to authorized users.
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Parsons B, Pan X, Xie L, Chen Y, Ortiz M, Whalen E. Comparison of the efficacy and safety of pregabalin for postherpetic neuralgia in Chinese and international patients. J Pain Res 2018; 11:1699-1708. [PMID: 30214280 PMCID: PMC6126478 DOI: 10.2147/jpr.s157856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Pregabalin is indicated for postherpetic neuralgia (PHN) in multiple countries, including China. This analysis compared pregabalin efficacy and safety in Chinese and international patients with PHN. Patients and methods Data from Chinese and international randomized, double-blind, placebo-controlled trials were compared. Pregabalin was administered at fixed (150, 300, or 600 mg/day) or flexible (150–600 mg/day) doses. The main efficacy measure was mean pain score change at endpoint on an 11-point numeric rating scale ranging from 0 = no pain to 10 = worst possible pain. Secondary efficacy measures included proportions of 30% and 50% pain responders, pain-related sleep interference (PRSI) scores, and proportions of Patient Global Impression of Change (PGIC) responders. The incidences of serious adverse events (SAEs) and adverse events (AEs) were used to assess safety. The effect of baseline pain severity on efficacy was tested. The proportions of patients with severe baseline pain who had moderate or mild pain at endpoint were also assessed. Results A total of 1166 patients were analyzed: 312 Chinese and 854 international. Overall, results were similar between Chinese and international patients. Pregabalin statistically significantly improved mean pain score versus placebo (least squares mean difference [95% CIs]: Chinese, −0.8 [–1.2, −0.5]; international, −1.3 [–1.6, −1.0]; both p<0.001). Pregabalin was statistically significantly better than placebo in Chinese and international patient groups in the proportions of 30% and 50% pain responders, PRSI scores, and proportions of PGIC responders. Baseline pain severity did not affect efficacy, except for some measures in Chinese patients with moderate baseline pain. Similar proportions of pregabalin-treated patients with severe baseline pain had moderate or mild pain at endpoint in both groups. SAE and AE profiles were comparable in Chinese and international patient groups, except incidences were commonly higher in international patients. Conclusion Chinese and international patients with PHN exhibit comparable pregabalin efficacy and safety, highlighting the utility of pregabalin for diverse PHN patient populations.
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Affiliation(s)
| | - Xiaoping Pan
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Li Xie
- Pfizer China, Beijing, China
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Merante D, Rosenstock J, Sharma U, Feins K, Hsu C, Vinik A. Efficacy of Mirogabalin (DS-5565) on Patient-Reported Pain and Sleep Interference in Patients with Diabetic Neuropathic Pain: Secondary Outcomes of a Phase II Proof-of-Concept Study. PAIN MEDICINE 2018; 18:2198-2207. [PMID: 28371941 DOI: 10.1093/pm/pnw342] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To evaluate the effects of mirogabalin on patient-reported pain and sleep interference in diabetic peripheral neuropathic pain (DPNP). Subjects Adults (≥18 years) with type 1 or 2 diabetes, glycosylated hemoglobin of 10% or less at screening, and DPNP for six months or more were eligible for participation. Methods Subjects (N = 452) were randomly assigned (2:1:1:1:1:1:1) to receive placebo, dose-ranging mirogabalin (5, 10, 15, 20, 30 mg/day), or pregabalin (300 mg/day) for five weeks. Secondary efficacy end points studied here included patient global impression of change (PGIC), modified brief pain inventory (BPI), and average daily sleep interference score (ADSIS). Correlation plots were generated to examine the relationship between ADSIS and average daily pain score (ADPS). Results At week 5, significant reductions in ADSIS were observed in the mirogabalin 15, 20, and 30 mg/day groups, compared with placebo (P < 0.05). Baseline ADSIS and ADPS were strongly correlated (R2 = 0.4407), as were mean changes from baseline in ADSIS and ADPS at week 5 (R2 = 0.6694). The mirogabalin 30 mg/day group showed significant improvement compared with placebo in four of six BPI subscales at end point; the mirogabalin 15 mg/day group showed significant improvement in three of six BPI subscales (P < 0.05). At end of treatment, the percentage of subject with PGIC status of "much improved or better" was greater in all mirogabalin dose groups than in the placebo group (P < 0.05). A low incidence of treatment-related adverse events was reported for mirogabalin. Conclusions Results support the effectiveness of mirogabalin in improving patient-reported pain and sleep interference in DPNP.
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Affiliation(s)
- Domenico Merante
- Daiichi Sankyo Development Ltd, Gerrards Cross, Buckinghamshire, UK
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, Texas
| | | | - Karen Feins
- Daiichi Sankyo Pharma Development, Edison, New Jersey
| | - Ching Hsu
- Daiichi Sankyo Pharma Development, Edison, New Jersey
| | - Aaron Vinik
- The Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Abstract
OBJECTIVES To evaluate whether orexin receptor antagonism with filorexant provides pain relief in patients with painful diabetic neuropathy (PDN). METHODS In this double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal proof-of-concept study, patients with PDN (aged 18 to 75 y) entered a 2-week, single-blind active run-in period with filorexant 10 mg nightly, before randomization 1:1 to placebo or filorexant in a 2-week, double-blind treatment period. The primary efficacy endpoint was time to efficacy failure among "primary responders" (≥30% decrease in evening pain intensity during the run-in). Secondary endpoints were time to efficacy failure among "all responders" (≥20% decrease in evening pain intensity during the run-in) and mean change from baseline in evening pain intensity throughout last 3 days of the double-blind period. RESULTS Of the 182 patients treated during the run-in, 170 were randomized in the double-blind period, including 65 primary responders and 88 responders. There was no significant difference in proportion of patients with efficacy failure during the double-blind period with filorexant versus placebo among primary (24.3% vs. 32.1% [P=0.411]) or all (34.0% vs. 43.9% [nominal P=0.302]) responders or in mean change from baseline in evening pain intensity scores (estimated treatment difference: -0.587 [P=0.269], primary; -0.687 [P=0.108], all). Adverse events were reported by 24.7% of patients during the run-in. A higher proportion of patients treated with filorexant versus placebo reported adverse events during the double-blind period (23.9% vs. 13.4%). DISCUSSION These data do not provide evidence for the efficacy of nightly filorexant for the treatment of PDN.
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Abstract
OBJECTIVE We report the results of a pilot, enrichment-design, placebo-controlled crossover trial of pregabalin for the treatment of prediabetic small-fiber neuropathic pain. METHODS Individuals with impaired fasting glucose or impaired glucose tolerance and neuropathic pain were evaluated according to UTAH Early Neuropathy Scale (UENS), Quantitative Sensory Testing, and intraepidermal nerve fiber density (IENFD). Symptoms were graded according to the Numeric Rating Scale (NRS). Individuals who responded to the administration of placebo were not eligible. Pregabalin was initiated at a dose of 75 mg qid and tapered up to 300 mg bid. Only individuals with a reduction of pain scores ≥30% were eligible to continue with the double-blind phase, which consisted of a randomized crossover period of 1 month of pregabalin and 1 month of placebo, with 7 days of washout between periods. RESULTS Forty-five participants were enrolled in the study. There was 36% reduction in the NRS from baseline after 1 month of single-blind pregabalin (NRS=5.1±2.6). Twenty-six participants were eligible for the double-blind phase. There was further reduction of pain in the double-blind pregabalin and the placebo groups, but the pregabalin group had a statistically significant reduction of pain (NRS=3.2±2.2 vs. 4.0±2; P<0.05). Participants who did not respond showed a lower IENFD than those who responded, suggesting more severe nerve damage. CONCLUSIONS This pilot study showed improvement of prediabetic neuropathic pain. Participants with higher pain scores at baseline had higher UENS scores and a lower IENFD. Limitations of the study include the small number of participants and the carry-over effect.
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D'Arcy Y, McCarberg B, Parsons B, Behar R, Thorpe A, Alexander A. Pregabalin for the treatment of neuropathic pain: a narrative review for primary care providers. Curr Med Res Opin 2017; 33:1353-1359. [PMID: 28426255 DOI: 10.1080/03007995.2017.1322051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Neuropathic pain (NeP) is a distinct type of pain caused by damage to the nervous system itself. This often severe and chronic type of pain requires specific treatments that target the underlying pain pathophysiology. AIM The purpose of the current narrative review is to provide an overview of pregabalin (Lyrica 1 ) for the treatment of NeP including its effects on pain, pain-related sleep interference, and other health-related outcomes, timing of therapeutic effect, safety and tolerability, and dosing. The information provided here will help primary care providers develop more effective NeP treatment strategies.
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Affiliation(s)
| | - Bill McCarberg
- b University of California San Diego , San Diego , CA , USA
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Almoznino G, Haviv Y, Sharav Y, Benoliel R. An update of management of insomnia in patients with chronic orofacial pain. Oral Dis 2017; 23:1043-1051. [DOI: 10.1111/odi.12637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- G Almoznino
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial center; Medical Corps; Israel Defense Forces; Tel-Hashomer Israel
| | - Y Haviv
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Hebrew University-Hadassah School of Dental Medicine; Jerusalem Israel
| | - R Benoliel
- Rutgers School of Dental Medicine; Rutgers, The State University of New Jersey; Newark NJ USA
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Ogawa S, Arakawa A, Hayakawa K, Yoshiyama T. Pregabalin for Neuropathic Pain: Why Benefits Could Be Expected for Multiple Pain Conditions. Clin Drug Investig 2017; 36:877-888. [PMID: 27448285 DOI: 10.1007/s40261-016-0423-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Limited research exists to support the extrapolation of the analgesic efficacy of pregabalin from one neuropathic pain condition to another. This retrospective analysis evaluated similarities in the efficacy of pregabalin for treating neuropathic pain associated with post-herpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), and spinal cord injury (SCI) in a Japanese population, as a basis for considering the extrapolation of these data to other neuropathic pain conditions. METHODS Data were analysed across pregabalin doses within each pain condition, from three comparable 13- to 16-week, randomized, double-blind, placebo-controlled trials (RCTs) and the corresponding 52-week, open-label extension trials of pregabalin in Japanese patients with PHN, DPN or SCI. Efficacy outcomes in the RCTs included endpoint and weekly mean pain and sleep interference scores; endpoint proportions of responders in pain; Patient Global Impression of Change scores; and 36-Item Short Form Health Survey (SF-36) scores or Hospital Anxiety and Depression Scale (HADS) assessments. Study discontinuation rates were compared between treatment groups. The extension trials assessed pain intensity, using the Short-Form McGill Pain Questionnaire. RESULTS In the RCTs for all pain conditions, significant improvements in comparison with placebo in mean pain and sleep interference scores were evident after 1 week with pregabalin and were sustained throughout the treatment periods (p < 0.05). At the study endpoint, in comparison with placebo, a significantly greater percentage of pregabalin-treated patients experienced a ≥30 % reduction in pain across the RCTs (p < 0.05), and pregabalin significantly improved six of 16 SF-36 subscale scores in the PHN and DPN trials (p < 0.05). In the SCI trial, pregabalin-treated patients had numerically better outcomes of HADS scores. In the extension trials, improvements in pain intensity were maintained over a 52-week period. CONCLUSION Similarities in the pregabalin efficacy profiles, including time to onset and magnitude of response, were confirmed regardless of the neuropathic pain condition. These data support the potential for extrapolating analgesic efficacy to other neuropathic pain conditions. CLINICALTRIALS. GOV IDENTIFIERS NCT00394901, NCT00553475, NCT00407745, NCT00424372, NCT00553280, NCT01202227.
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Affiliation(s)
- Setsuro Ogawa
- Department of Anesthesiology, Nihon University School of Medicine/Surugadai Nihon University Hospital, Tokyo, Japan
| | - Akio Arakawa
- Portfolio and Project Management, Pfizer Japan Inc., Tokyo, Japan
| | | | - Tamotsu Yoshiyama
- Clinical Statistics, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
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Abstract
Insomnia is the forgotten partner to many medical problems, not least chronic pain where interference with sleep is a common complaint. However, the relationship is complex: lack of sleep can exacerbate pain through increase in proinflammatory cytokine production. Acupuncture is observed clinically to improve sleeping in chronic pain patients, but reviews are unable firmly to recommend acupuncture for insomnia as many trials are methodologically inadequate, despite most being acupuncture positive. However, there is strong evidence for relief in several chronic pain problems and improvement in these is likely also to restore normal sleeping. So, as the safety profile of acupuncture is excellent, it seems reasonable to utilize acupuncture in a nonpharmacological approach to combating insomnia, despite lack of formal evidence.
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Affiliation(s)
- Simon Hayhoe
- Formerly of: Pain Management Department, University Hospital, Turner Road, Colchester, CO4 5JL, UK
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Liu Q, Chen H, Xi L, Hong Z, He L, Fu Y, Fang H, Shang N, Yan P, Fan D. A Randomized, Double-blind, Placebo-controlled Trial to Evaluate the Efficacy and Safety of Pregabalin for Postherpetic Neuralgia in a Population of Chinese Patients. Pain Pract 2015; 17:62-69. [PMID: 26714731 DOI: 10.1111/papr.12413] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Currently, there are limited options for treatment of postherpetic neuralgia (PHN) patients in China. While pregabalin is an effective treatment option for PHN in several countries, there is limited information on its efficacy in Chinese patients. METHODS This was an 8-week, double-blind, placebo-controlled trial in Chinese patients with PHN randomized (1:1) to pregabalin 300 mg/day or placebo. Primary efficacy endpoint was change from baseline in mean pain score (Daily Pain Rating Scale; 0 = 'no pain' to 10 = 'worst possible pain'). Secondary efficacy endpoints included change from baseline in overall pain intensity score, by visual analog scale (VAS; 0 = 'no pain' to 100 = 'worst possible pain') and daily sleep interference score (0 = 'pain does not interfere with sleep' to 10 = 'completely interferes'). RESULTS A total of 220 patients were randomized and received treatment (111 pregabalin and 109 placebo). Improvement in mean pain score with pregabalin was significantly greater than placebo, least squares mean difference (95% CI), -0.71 (-1.08, -0.34); P = 0.0002. Improvements in VAS and sleep interference score at endpoint were significantly greater with pregabalin than placebo, least squares mean difference (95% CI), -8.18 (-11.99, -4.37); P < 0.0001, and -0.54 (-0.93, -0.14); P = 0.0079, respectively. Adverse events were consistent with current product labeling, with dizziness the most commonly reported adverse event (24.3% of pregabalin-treated patients). CONCLUSION Pregabalin improved measures of pain and sleep, and is well tolerated in Chinese patients with PHN. These results may inform physicians treating patients with PHN in China.
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Affiliation(s)
- Quanzhong Liu
- Dermatology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Haibo Chen
- Neurology Department, Beijing Hospital, Beijing, China
| | - Liyan Xi
- Dermatology Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guandong, China
| | - Zhen Hong
- Neurology Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Li He
- Neurology Department, West China Hospital of Sichuan University, Sichuan, China
| | - Yi Fu
- Neurology Department, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Fang
- The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, China
| | - Ningxiu Shang
- Pfizer (China) Clinical Science Department, Global Innovative Pharma Business, Beijing, China
| | - Ping Yan
- Pfizer (China) Research & Development Center, Shanghai, China
| | - Dongsheng Fan
- Neurology Department, Peking University Third Hospital, Beijing, China
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Taguchi T, Igarashi A, Watt S, Parsons B, Sadosky A, Nozawa K, Hayakawa K, Yoshiyama T, Ebata N, Fujii K. Effectiveness of pregabalin for the treatment of chronic low back pain with accompanying lower limb pain (neuropathic component): a non-interventional study in Japan. J Pain Res 2015; 8:487-97. [PMID: 26346468 PMCID: PMC4531006 DOI: 10.2147/jpr.s88642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the impact of pregabalin on sleep, pain, function, and health status in patients with chronic low back pain with accompanying neuropathic pain (CLBP-NeP) under routine clinical practice. Methods This prospective, non-interventional, observational study enrolled Japanese adults (≥18 years) with CLBP-NeP of duration ≥3 months and severity ≥5 on a numerical rating scale (0= no pain, 10= worst possible pain). Treatment was 8 weeks with pregabalin (n=157) or usual care alone (n=174); choice of treatment was determined by the physician. The primary efficacy outcome was change from baseline to 8 weeks in pain-related interference with sleep, assessed using the Pain-Related Sleep Interference Scale (PRSIS; 0= did not interfere with sleep, 10= completely interferes with sleep). Secondary endpoints were changes in PRSIS at week 4, and changes at weeks 4 and 8 in pain (numerical rating scale), function (Roland-Morris Disability Questionnaire), and quality of life (EuroQol 5D-5L); global assessments of change were evaluated from the clinician and patient perspectives at the final visit. Results Demographic characteristics were similar between cohorts, but clinical characteristics suggested greater disease severity in the pregabalin group including a higher mean (standard deviation) pain score, 6.3 (1.2) versus 5.8 (1.1) (P<0.001). For the primary endpoint, pregabalin resulted in significantly greater improvements in PRSIS at week 8, least-squares mean changes of −1.3 versus −0.4 for usual care (P<0.001); pregabalin also resulted in greater PRSIS improvement at week 4 (P=0.012). Relative to usual care at week 8, pregabalin improved pain and function (both P<0.001), and showed global improvements since beginning study medication (P<0.001). Pregabalin was well tolerated. Conclusion In clinical practice in patients with CLBP-NeP, pregabalin showed significantly greater improvements in pain-related interference with sleep relative to usual care. In addition, pregabalin significantly improved pain, function, and health status, suggesting the benefits of pregabalin for overall health and well-being relative to usual care in these patients. (Clinicaltrials. gov identifier NCT02273908).
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Affiliation(s)
- Toshihiko Taguchi
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ataru Igarashi
- Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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