Facial Pain Unit and Pain Management Centre, University College London Hospitals NHS Foundation Trust/University College London, London, UK.
Biogen, Cambridge, MA.
Clin J Pain. 2018 Aug;34(8):691-699. doi: 10.1097/AJP.0000000000000595.
Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN.
Included patients were aged 18 years and above, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the previous year), continuously enrolled 1 year before index, with ≥3 years' follow-up postindex. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN.
In total, 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; age, mean [SD], 59 [15] y). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). In total, 65% of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN.
In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps because of suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.
三叉神经痛（TN）是一种罕见的面部疾病，其特征为第五颅神经区域出现严重的单侧阵发性疼痛。临床指南推荐卡马西平（美国食品和药物管理局批准的唯一治疗 TN 的药物）和奥卡西平作为一线治疗药物。我们利用美国 Truven Health MarketScan 数据库，研究了 TN 患者的治疗模式。
纳入的患者年龄在 18 岁及以上，新诊断为 TN（≥2 次 TN 诊断，间隔≥14 天；前一年无诊断），在索引前连续入组 1 年，索引后有≥3 年的随访。我们评估了选择的药物治疗（卡马西平、奥卡西平、普瑞巴林、加巴喷丁、巴氯芬、度洛西汀、托吡酯）、手术（后颅窝、放射外科）和注射（周围麻醉注射、三叉神经节手术）在 TN 中的应用。
共纳入 3685 例患者（2425 例商业保险，1260 例医疗保险；71.8%为女性；年龄，平均值[标准差]，59[15]岁）。总体而言，72.5%的患者接受了至少 1 种研究药物治疗，最常见的是卡马西平（51.7%）或加巴喷丁（48.6%）。总的来说，65%的药物治疗患者有≥2 次治疗发作；41.6%有≥3 次（定义为药物治疗[单药/联合]方案的改变）。总体而言，12.3%的患者接受了手术，7.3%的患者接受了注射；42.9%的患者因 TN 而接受了阿片类药物治疗。
在美国，诊断后 3 年内，尽管卡马西平是唯一批准的药物，但患有 TN 的患者会接受多种药物治疗，包括阿片类药物。相当一部分患者会接受手术/注射治疗。接受药物治疗的患者中有很大一部分会经历多次治疗发作，这表明经常需要换药，这可能是因为疗效/耐受性不理想。我们的数据表明，TN 患者的疾病负担很高。
