Abstract

BackgroundIn randomised studies, the capsaicin 8% patch has demonstrated effective pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies.MethodsASCEND was an open-label, non-interventional study of patients with non-diabetes-related PNP who received capsaicin 8% patch treatment, according to usual clinical practice, and were followed for ≤52 weeks. Co-primary endpoints were percentage change in the mean numeric pain rating scale (NPRS) ‘average daily pain’ score from baseline to the average of Weeks 2 and 8 following first treatment; and median time from first to second treatment. The primary analysis was intended to assess analgesic equivalence between post-herpetic neuralgia (PHN) and other PNP aetiologies. Health-related quality of life (HRQoL, using EQ-5D), Patient Global Impression of Change (PGIC) and tolerability were also assessed.ResultsFollowing first application, patients experienced a 26.6% (95% CI: 23.6, 29.62; n = 412) reduction in mean NPRS score from baseline to Weeks 2 and 8. Equivalence was demonstrated between PHN and the neuropathic back pain, post-operative and post-traumatic neuropathic pain and ‘other’ PNP aetiology subgroups. The median time from first to second treatment was 191 days (95% CI: 147, 235; n = 181). Forty-four percent of all patients were responders (≥30% reduction in NPRS score from baseline to Weeks 2 and 8) following first treatment, and 86.9% (n = 159/183) remained so at Week 12. A sustained pain response was observed until Week 52, with a 37.0% (95% CI: 31.3, 42.7; n = 176) reduction in mean NPRS score from baseline. Patients with the shortest duration of pain (0–0.72 years) experienced the highest pain response from baseline to Weeks 2 and 8. Mean EQ-5D index score improved by 0.199 utils (responders: 0.292 utils) from baseline to Week 2 and was maintained until Week 52. Most patients reported improvements in PGIC at Week 2 and at all follow-up assessments regardless of number of treatments received. Adverse events were primarily mild or moderate reversible application site reactions.ConclusionIn European clinical practice, the capsaicin 8% patch provided effective and sustained pain relief, substantially improved HRQoL, improved overall health status and was generally well tolerated in a heterogeneous PNP population.Trial registrationNCT01737294 Date of registration - October 22, 2012.

Highlights

  • In randomised studies, the capsaicin 8% patch has demonstrated effective pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies

  • Prior and concomitant medications were recorded at baseline and patients were categorised by the treating physician as being in the primary, secondary or tertiary stage of the treatment pathway

  • Patient characteristics A total of 429 patents were enrolled in the study and 420 patients received at least one treatment with the capsaicin 8% patch (FAS)

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Summary

Introduction

The capsaicin 8% patch has demonstrated effective pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies. The latest treatment guidance from the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain recommends several options for first line treatment of neuropathic pain (NP), including calcium α2-δ ligands (e.g. pregabalin, gabapentin), serotonin/norepinephrine reuptake inhibitors and tricyclic antidepressants [6]. Despite proven efficacy, these therapies have limitations including inadequate pain relief, lengthy dose-titration periods, multiple daily dosing, dose-limiting adverse events, suboptimal adherence due to adverse events, and the potential for abuse and addiction [7,8,9]. Localised treatment with the capsaicin 8% patch limits the potential for drug–drug interactions and avoids the need for dose adjustment in the elderly or in patients with renal or hepatic impairment [11]

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