Neurological

Patch treated with lidocaine is effective in treating postherpetic neuralgia

A patch treated with lidocaine is both effective and well-tolerated for the treatment of postherpetic neuralgia, according to the results of a real-life study published in Pain Management.

The researchers therefore tried to use data from the German Pain-e-Register to provide supporting evidence from practice for the use of 700 mg of lidocaine-containing patches for the treatment of postherpetic neuralgia.

Researchers conducted a non-interventional retrospective cohort study to compare the tolerability and effectiveness of patches containing lidocaine with other first-line oral systemic treatments in patients who failed to respond to at least one recommended first-line oral medication.

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Data from patients who started treatment before December 2018 but before July 2019 were extracted. Patients with a 3-month history of pain and medically confirmed peripheral neuropathic pain were assessed. The effectiveness of the treatment was determined on the basis of the information reported by patients on pain intensity, daily pain-related impairments and quality of life as well as the general quality of life and the global impression of the change.

A total of 3081 patients with peripheral neuropathic pain, 1711 of them with postherpetic neuralgia, were included in the analysis after propensity score matching. Most of the participants were women over 60 years of age and almost all of them had comorbidities and were taking concomitant medications. More than 60% of the patients had a pain duration of more than 1 year. At the start of the study, the pain intensity was high and accompanied by “considerable impairments” in daily activities and a significant impairment in quality of life.

Patients in the patch group treated with lidocaine received an average of 1.8 ± 0.9 patches per day (range 1-4 patches) with a mean treatment duration of 145 ± 46.3 days. In more than 26% of the patients, the medication was stopped prematurely, mainly because pain treatment was no longer necessary (15.7%). Other reasons were adverse events (4.8%), lack of efficacy (3.9%), and unclear information (2.2%).

Patients in the oral medication group received tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors, or anti-epileptic drugs (32.3%, 32.3% and 35.5%, respectively). These drugs mainly included pregabalin, duloxetine, and amitriptyline. The mean duration of treatment was 102.9 ± 66.7 days, and a total of 53.8% of patients in this group discontinued therapy.

At the start of the study, all patients received analgesic medication at the same time. Most received up to 2 additional treatments for peripheral neuropathic pain. After 24 weeks, there was a significant reduction in the concomitant medication in the lidocaine group compared to the oral medication group (94.1% vs. 70.9%).

Both treatment groups experienced a decrease in pain intensity during the observation period; however, this decrease was greater in the lidocaine group. The reduction in the absolute change in the mean pain intensity index from baseline was significantly higher in the lidocaine group at weeks 4, 12 and 24 with a strong effect size. The mean absolute least squares difference across all time points was -13.0 ± 14.5 (95% CI, -13.8 to -12.3) mm VAS; the corresponding effect size was 1.1 (95% CI, 1.1-1.2). After 24 weeks, the relative mean change in pain intensity index was 52.5% and 29.4% for the lidocaine and oral medication groups, respectively.

At the start of the study, the patients experienced significant restrictions in the activities of daily living. These improved with both treatments over the observation period, but were significantly higher in the lidocaine group. There were also notable improvements in both pain-related and general quality of life from baseline.

There were significantly fewer drug-related side effects in the lidocaine group (8.9% versus 58.1% in the oral medication group). These patients reported mainly about the application site and other skin-specific reactions. In the oral medication group, 24.2% of patients had nervous system adverse events, 23.2% psychiatric adverse events, and 17.1% gastrointestinal adverse events. The most common side effects were drowsiness and dizziness, nausea and hyperhidrosis (15.8% and 5.1% of all patients, respectively).

Study limitations include those associated with observational, retrospective database research and a lack of generalizability outside of the narrowly defined study population.

“Analysis of real data … confirmed the effectiveness and good tolerability of the patch containing lidocaine 700 mg under routine medical care,” the researchers concluded.

Disclosure: This clinical study was supported by Grünenthal GmbH, Germany. For a full list of the author’s disclosures, see the original reference.

reference

Everywhere MA, Eerdekens M, Hollanders E, Bösl I, Sabatschus I. Lidocaine 700 mg active plaster for postherpetic neuralgia: real-world data from the Germain Pain e-Registry. Pain management. Published online 10 August 2021. doi: 10.2217 / pmt-2021-0022

This article originally appeared on Clinical Pain Advisor

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