Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials

Onakpoya, Igho; Thomas, Elizabeth T; Lee, Joseph; Goldacre, Ben; Heneghan, Carl

doi:10.1136/bmjopen-2018-023600

Cited by 83 publications

(75 citation statements)

References 58 publications

(31 reference statements)

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“…Following the PBS subsidy of pregabalin, we observed high rates of pregabalin initiation from 2013/14 to 2016/17 with only a slight drop in 2017/18. However, consistent with other studies, 7,17,18 we observed high rates of discontinuation which have been increasing over time, suggesting suboptimal efficacy or low tolerability of pregabalin for the conditions for which it is being used. The lower discontinuation rates in people that initiated on the higher capsule strengths may indicate a better risk–benefit profile, use for different indications, or use in different populations.…”

Section: Discussionsupporting

confidence: 90%

Patterns of pregabalin initiation and discontinuation after its subsidy in Australia

Chiu

Brett

Pearson

et al. 2020

Brit J Clinical Pharma

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Following the 2013 public subsidy of pregabalin in Australia for neuropathic pain not responding to other medicines, use and misuse increased substantially. We used pharmaceutical dispensing claims for a 10% sample of Australians to quantify initiation, discontinuation and dispensing of other analgesics before and after initiation. We identified 130 770 people initiating pregabalin between 2013/14 and 2017/18 (median age: 61 years; 56.8% female). Discontinuation rates at 1‐year increased from 77.0% in 2013/14 to 85.9% in 2017/18; 38% only had 1 dispensing. Approximately 1/3 (37.5%) initiated on the lowest strength capsule (25 mg) with only 31.2% later up‐titrating to a higher strength. 47.4% and 53.0% were dispensed opioids within 180 days before and after pregabalin initiation, respectively. Many individuals are using pregabalin for short treatment durations and low dose ranges not consistent with treatment of neuropathic pain, which is generally a chronic condition. This may suggest poorer tolerability than observed in clinical trials, or use for other conditions, some of which may be for indications where the balance of benefits and risk is less clear.

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Section: Discussionsupporting

confidence: 90%

Patterns of pregabalin initiation and discontinuation after its subsidy in Australia

Chiu

Brett

Pearson

et al. 2020

Brit J Clinical Pharma

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“…One issue not so often taken into consideration is the documentation of the treatment effect of gabapentinoids also in conditions where they are approved. One recent review of pregabalin in the management of neuropathic pain [107] concludes that pregabalin has a beneficial effect on some symptoms of neuropathic pain, but its use is associated with a number of adverse events and the overall quality of evidence supporting its use is low. The authors advocate a need for larger, robust, high-quality clinical trials with particular attention paid to minimizing selective reporting of outcomes.…”

Section: Recommendations To Healthcare Providersmentioning

confidence: 99%

Current Evidence on Abuse and Misuse of Gabapentinoids

2020

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This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.

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“…Thus, there is insufficient evidence to make definitive statements on pregabalin's effects on QoL. 31 The capsaicin 179 mg patch is not associated with a daily pill burden, and adherence to treatment is determined by whether patients complete the intended application time. In phase III clinical trials, almost all (97-100%) of the patients completed ≥90% of the full duration of treatment (ie the patch was not removed early).…”

Section: The Capsaicin 179 Mg Patch Is Associated With a Lower Burdenmentioning

confidence: 99%

<p>Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain</p>

Huygen¹,

Kern²,

Pérez

2020

JPR

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Background and Objective: Treatment of peripheral neuropathic pain (PNP) remains a challenge. In the absence of clear predictors of response, clinical decision-making involves trial and error. While many classes of pharmacological agent are used and have shown efficacy, one of the most commonly used first-line treatments is pregabalin. However, in the 60% of PNP cases in which the pain is localized, a local treatment may be more suitable. This article will summarize the evidence for the relative effectiveness and tolerability of the capsaicin 179 mg patch and pregabalin in the treatment of PNP and highlight the expert opinion of the authors based on their own clinical experiences. Results: When compared in a head-to-head trial in patients with PNP, capsaicin 179 mg patch provided non-inferior pain relief compared with an optimized dose of pregabalin, as well as a reduction in dynamic mechanical allodynia, faster onset of action, fewer systemic side effects, and greater treatment satisfaction. Adverse events associated with capsaicin patch are mainly application site reactions, compared with systemic and central nervous system effects with pregabalin. Studies indicate that capsaicin 179 mg patch is associated with a lower burden of therapy than pregabalin in terms of improved tolerability, lack of a daily pill burden, lack of drug-drug interactions, and increased regimen flexibility. Conclusion: In localized neuropathic pain, evidence supports a pragmatic approach of using a local treatment before considering a systemic treatment. For treatment selection, the patient profile (eg, concomitant medication use, age) and the treatments' efficacy and tolerability profiles should be considered.

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Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials

Cited by 83 publications

References 58 publications

Patterns of pregabalin initiation and discontinuation after its subsidy in Australia

Patterns of pregabalin initiation and discontinuation after its subsidy in Australia

Current Evidence on Abuse and Misuse of Gabapentinoids

<p>Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain</p>

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