Bardo-Brouard P, Luizard C, Valeyrie-Allanore L, Goujon C, Do B, Colin A, Wolkenstein P, Paul M
a Pharmacy Department , Henri Mondor University Hospital , Créteil , France.
b Dermatology Department , Neurofibromatosis Reference Center, Henri Mondor University Hospital , Créteil , France.
Curr Med Res Opin. 2018 May;34(5):887-891. doi: 10.1080/03007995.2018.1433142. Epub 2018 Feb 21.
The aim of this case series was to report the use of 8% topical capsaicin patch (marketed under the trade name Qutenza) in the management of refractory neuropathic pain (NP) in adult patients with type 1 neurofibromatosis (NF1).
Capsaicin has been suggested for NF1 patients suffering from refractory peripheral NP despite several years of analgesic treatments. The patch was applied for 60 minutes on the painful area, with tolerability control (blood pressure, intensity of pain and dermal reaction). The evaluation was done at the beginning of treatment and during the 2 months following the first treatment (phone calls at weeks 1, 2, 4 and 8). The primary efficacy criterion was the response rate: a patient was considered to be responding if he or she reported an average relief ≥30% at the time of the follow-up calls. The secondary criteria were: interference scores (QCD), Patient Global Impression of Change (PGIC) and overall treatment satisfaction, self-reported by the patient.
Eight patients (5 females/3 males, 41.8 ± 8.2 years of age) received a first treatment with capsaicin. Patients had pre-existing pain for 6.6 years (±6.0) and were currently receiving an average of 6.1 (±3.9) different analgesics. The response rate was 37.5%. The three responders felt globally improved and satisfied, with the improvement in overall condition as interference scores decreased. Apart from the expected local reactions, the treatment was not accompanied by systemic side effects.
As suggested in this case series, capsaicin provided pain relief in certain NF1 patients with resistant NP. The response rate is that expected in multi-line refractory NP. A significant benefit on the overall condition of some patients was observed. In addition, this topical treatment is administered every 3 months without systemic effects. This study is limited by the small number of patients, but was intended to describe a new and well tolerated alternative treatment.
本病例系列旨在报告8%辣椒素贴剂（商品名Qutenza）在1型神经纤维瘤病（NF1）成年患者难治性神经性疼痛（NP）管理中的应用。
尽管经过数年镇痛治疗，辣椒素已被推荐用于患有难治性周围性NP的NF1患者。将贴剂贴于疼痛部位60分钟，并进行耐受性控制（血压、疼痛强度和皮肤反应）。在治疗开始时以及首次治疗后的2个月内（第1、2、4和8周电话随访）进行评估。主要疗效标准为缓解率：如果患者在随访电话时报告平均缓解率≥30%，则认为该患者有反应。次要标准包括：干扰评分（QCD）、患者整体变化印象（PGIC）以及患者自我报告的总体治疗满意度。
8例患者（5例女性/3例男性，年龄41.8±8.2岁）接受了首次辣椒素治疗。患者既往疼痛6.6年（±6.0），目前平均正在接受6.1（± 3.9）种不同的镇痛药治疗。缓解率为37.5%。三名有反应者总体感觉病情改善且满意，随着干扰评分降低，整体状况有所改善。除了预期的局部反应外，该治疗未伴有全身副作用。
如本病例系列所示，辣椒素可使某些患有难治性NP的NF1患者疼痛缓解。缓解率与多线难治性NP的预期缓解率相符。观察到对部分患者的整体状况有显著益处。此外，这种局部治疗每3个月进行一次，无全身影响。本研究受患者数量少的限制，但旨在描述一种新的耐受性良好的替代治疗方法。
