Abstract
BackgroundMirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels. Both pregabalin and mirogabalin act as nonselective ligands at the α2δ-1 and α2δ-2 subunits. Mirogabalin has a unique binding profile and long duration of action. Pregabalin has been reported to produce intolerable adverse effects in some patients. This study investigated outcomes associated with mirogabalin administration in patients with peripheral neuropathic pain who ceased treatment with pregabalin.MethodsWe retrospectively assessed peripheral neuropathic pain using the neuropathic pain screening questionnaire (NeP score) in 187 patients (58 men, 129 women) who were treated with mirogabalin. All patients had switched from pregabalin to mirogabalin due to lack of efficacy or adverse events. Differences in the treatment course (i.e., numeric rating scale (NRS) scores) were compared using one-way analysis of variance with Bonferroni post hoc tests.ResultsThe mean age of the patients was 72.3 years (range, 30–94 years), and the mean duration of disease was 37 months (range, 3–252 months). After treatment with mirogabalin for 1 week, NRS scores significantly decreased compared with baseline and continued to decrease over time. After 8 weeks, NRS scores improved by ≥ 30% from baseline in 113 patients (69.3%). Twenty-four patients (12.8%) stopped mirogabalin treatment due to adverse events. Somnolence (26.7%), dizziness (12.3%), edema (5.9%), and weight gain (0.5%) were noted as adverse events of mirogabalin.ConclusionsThe results of this investigation indicate that mirogabalin is safe and effective for reducing peripheral neuropathic pain.
Highlights
Mirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels
We examined the outcomes with mirogabalin as a rescue drug in patients with peripheral neuropathic pain who developed moderate side effects from pregabalin treatment
Adverse events leading to the switch from pregabalin to mirogabalin included somnolence (97 patients, 28.8%), dizziness (50 patients, 14.8%), edema (7 patients, 2.1%), weight gain (3 patients, 0.9%), epigastralgia (2 patients, 0.6%), and fatigue (2 patients, 0.6%)
Summary
Mirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels. Both pregabalin and mirogabalin act as nonselective ligands at the α2δ-1 and α2δ-2 subunits. Pregabalin is a ligand for the α2δ subunit of voltagesensitive calcium channels and is recommended as the first-line drug for neuropathic pain in guidelines around the world [6]. It decreases the release of neurotransmitters such as glutamate, noradrenalin, and substance P, which leads to pain relief [7]. The clinical utility of pregabalin may be limited by CNS adverse events [14]
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