Capsaicin Patch Superior to Pregabalin for Alleviating, Resolving Dynamic Mechanical Allodynia

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Among the secondary outcomes evaluated in the the ELEVATE trial were the area and intensity of dynamic mechanical allodynia.
Among the secondary outcomes evaluated in the the ELEVATE trial were the area and intensity of dynamic mechanical allodynia.

The capsaicin 8% patch Qutenza® may be more effective than pregabalin to reduce the intensity and area of dynamic mechanical allodynia (DMA). The patch may also be more effective to bring about complete resolution of the disorder, according to a randomized open-label study published in the European Journal of Pain.

The area and intensity of DMA were among the secondary outcomes evaluated in the ELEVATE phase 4 trial, which compared the efficacy of pregabalin and Qutenza in patients with postherpetic neuralgia, peripheral nerve injury, or nondiabetic painful peripheral neuropathy (Clinicaltrials.gov identifier: NCT01713426).

During an 8-week period, a total of 488 patients with neuropathic pain and DMA were managed with the capsaicin 8% patch (n=253) or an optimized dose of pregabalin (n=235).

Patients treated with Qutenza vs pregabalin had greater reduction in intensity of allodynia (-2.98±0.20 vs -2.35±0.21; 95% CI, -1.04, -0.23; P =.002) and greater reduction in the DMA area (-72.6 cm2 vs -39.5 cm2; 95% CI, -69.1, -10.0; P =.009) after 8 weeks of treatment. More patients receiving capsaicin experienced complete elimination of allodynia than those receiving pregabalin therapy (24.1% vs 12.3%, respectively; P =.001).

The open-label design and relatively short study duration represent limitations of the ELEVATE trial. The researchers also caution against generalizing these findings to other forms of allodynia in patients with neuropathic and/or non-neuropathic conditions.

Overall, they suggest that the superiority of capsaicin over pregabalin “may be due to capsaicin's ability to act on both central and peripheral sensitization.”

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Reference

Cruccu G, Nurmikko TJ, Ernault E, Riaz FK, McBride WT, Haanpää. Superiority of capsaicin 8% patch versus oral pregabalin on dynamic mechanical allodynia in patients with peripheral neuropathic pain [published online December 1, 2017]. Eur J Pain. doi: 10.1002/ejp.1155

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