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If patients don’t respond to capsaicin patches for neuropathic pain, try again

PAINWeek 2020
Reuters Health - 02/10/2020 - Patients with peripheral neuropathic pain who don't initially respond to capsaicin patches may end up responding later.

That's according to a post-hoc analysis of two 52-week studies presented virtually at the PAINWeek 2020 virtual conference from September 11-13.

"Although at month 12, the responder rates in patients who did not initially respond to HCCP were approximately 10% lower than in the overall population, the substantial increase in responder rates . . . justifies a repeat treatment," Dr. Rainer Freynhagen of Benedictus Hospital Tutzing in Tutzing, Germany, and colleagues write in their conference abstract.

The researchers analyzed two studies on capsaicin 8% patches. The observational STRIDE trial (https://bit.ly/36q0M3d), published in 2017, included 306 patients with nondiabetic peripheral neuropathic pain. The 2019 PACE randomized controlled trial (https://bit.ly/3cQckOh) included 468 patients with diabetic neuropathic pain.

In STRIDE, 76.6% of patients did not respond to a first treatment, in which response is defined as 30% or greater decrease in pain on the Numeric Pain Rating Scale. When the trial closed at 12 months, 34% of the 68% of non-responders who remained had responded to treatment. In comparison, 44% of the 57% of all patients who remained in the study responded.

That 10-percentage-point difference in response rates held for both trials analyzed. In PACE, 54% of patients did not respond to a first treatment. Of the initial non-responders still enrolled by the twelfth month (84%), 46% became responsive, compared to 58% of the 79% of the total population that remained.

The findings come as no surprise to Dr. Nathaniel Katz, chief science officer at WCG Analgesic Solutions in Natick, Massachusetts, who co-authored the PACE study but was not involved in this new analysis.

"Don't give up if the patient doesn't get much of a response from the first patch application. Also, two previous trials suggest the possibility of actual improvement in neurological function with long-term treatment with the high-dose capsaicin patch, which is something for clinicians to keep in mind," Dr. Katz told Reuters Health by email.

Dr. Freynhagen was unavailable for comment.

By Rob Goodier

SOURCE: https://bit.ly/3mZrkyc PAINWeek. September 11-13, 2020.

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