Trigeminal Neuralgia: Assessing Treatment Patterns to Improve Outcomes

In a 3-year period, 45% of patients with trigeminal neuralgia received at least 3 unique treatments.

Patients with trigeminal neuralgia face a significant burden of illness and have needs currently unmet by available therapies, according to data presented at the American Pain Society’s 36th Annual Scientific Meeting in Pittsburgh, Pennsylvania.1

There is currently only 1 drug — carbamazepine — approved by the US Food and Drug Administration for the treatment of trigeminal neuralgia, which is characterized by severe, unilateral, paroxysmal pain in the area of the trigeminal nerve. However, many other drugs and procedures are used off label in an attempt to quell the orofacial pain.

In order to better understand current treatment patterns, a team of researchers led by Ning Wu, PhD, of Biogen, examined data from a cohort of 3685 patients (72% women) with trigeminal neuralgia from the Truven Health MarketScan® database. Patients were at least 18 years old with at least 3 years of follow-up available after first diagnosis. Common comorbidities included hypertension (41.2%), osteoarthritis (18.5%), lower back pain (18.1%), and diabetes (12.7%).

Among the cohort, 76% received at least 1 treatment, either monotherapy/combination pharmacotherapy or procedure, in the first 3 years after diagnosis. Of those, 65% received at least 2 and 45% received at least 3 unique treatment regimens, defined as a change in pharmacotherapy or procedure, over the 3-year period. Of the 72% who received at least 1 pharmacotherapy, carbamazepine was most common (38%), followed by gabapentin (35%), pregabalin (17%), and oxcarbazepine (15%). Of the 19.6% who underwent a procedure (anesthetic/ botulinum toxin injections or neurosurgical procedures), 70% required additional pharmacotherapy for pain relief. Notably, nearly 43% of the cohort received opioids; among those without other pain comorbidities, 39.3% received opioids.

The number of treatments used over the 3-year period suggest switching of pharmacotherapy due to “suboptimal efficacy/tolerability,” the researchers wrote, with similar trends seen in patients who underwent procedures. “Overall these data indicate a high burden-of-illness associated with TN and its treatment, and unmet needs with current therapies,” they concluded.

Drs Wu, Werneburg, Hoffman, and Liu report being employed by Biogen. The study was sponsored by Biogen.

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  1. Wu N, Lee J, Zakrzewska J, Werneburg B, Hoffman D, Liu Y. Trigeminal neuralgia: pharmacotherapy and surgical treatment patterns in the United States. Presented at: American Pain Society 36th Annual Scientific Meeting. May 17-20, 2017; Pittsburgh, PA.