Shaparin Naum, Slattum Patricia W, Bucior Iwona, Nalamachu Srinivas
*Montefiore Pain Center, Bronx, NY †Virginia Commonwealth University, Department of Gerontology, Richmond, VA ‡Depomed Inc., Newark, CA §International Clinical Research Institute, Overland Park, KS.
Clin J Pain. 2015 Nov;31(11):983-91. doi: 10.1097/AJP.0000000000000206.
To characterize risk factors for occurrence of adverse events (AEs) and treatment discontinuations due to AEs for improving safety and tolerability of treatment of postherpetic neuralgia (PHN).
Patients with PHN (n=556) received 1800 mg once-daily gastroretentive gabapentin (G-GR) in 2 phase 3 and 1 phase 4 study. Safety assessments included the incidence and severity of AEs and analysis of discontinuations due to AEs. Multivariable, logistic regression analyses examined predictors of AE reporting and discontinuations due to AEs.
In total, 53.2% of patients reported any AE, and 12.9% discontinued because of AEs. Both AE incidence and treatment discontinuations decreased rapidly during the 2-week titration to sustained, low levels. The probability to report any AE was 0.6 for females versus 0.4 for males, whereas there were no differences in probabilities for age (less than 75 vs. 75 y and older) and race (nonwhite vs. white). Consistent with this, only female sex was a significant (P=0.0006) predictor of AE reporting. Experiencing moderate (P≤0.0001) or severe (P=0.0006) AEs, but not patient demographics, was predictive of treatment discontinuations. The probability of discontinuation due to moderate AEs was 0.4 and 0.5 for severe AEs.
The tolerability of G-GR was not affected by patient age, but was affected by AE severity. Although being female was predictive of reporting AEs, it did not influence treatment discontinuation. Given that PHN is a disease for which the risk and duration of PHN increases with age and with being female, G-GR appears to be a well-suited treatment option for PHN.
确定不良事件(AE)发生的风险因素以及因AE导致治疗中断的风险因素,以提高带状疱疹后神经痛(PHN)治疗的安全性和耐受性。
556例PHN患者在2项3期和1项4期研究中接受每日1次1800 mg的胃内滞留型加巴喷丁(G-GR)治疗。安全性评估包括AE的发生率和严重程度以及对因AE导致治疗中断情况的分析。多变量逻辑回归分析检查了AE报告和因AE导致治疗中断的预测因素。
总体而言,53.2%的患者报告了任何AE,12.9%的患者因AE而停药。在为期2周的滴定至持续低水平期间,AE发生率和治疗中断率均迅速下降。女性报告任何AE的概率为0.6,男性为0.4,而年龄(小于75岁与75岁及以上)和种族(非白人与白人)的概率没有差异。与此一致的是,只有女性是AE报告的显著预测因素(P=0.0006)。经历中度(P≤0.0001)或重度(P=0.0006)AE,但不是患者人口统计学特征,是治疗中断的预测因素。因中度AE停药的概率为0.4,因重度AE停药的概率为0.5。
G-GR的耐受性不受患者年龄的影响,但受AE严重程度的影响。虽然女性是AE报告的预测因素,但它不影响治疗中断。鉴于PHN是一种风险和持续时间随年龄和女性因素增加的疾病,G-GR似乎是一种非常适合PHN的治疗选择。