Substitution of Gabapentin Therapy with Pregabalin Therapy in Neuropathic Pain d

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Pain Med. 2010 Jan 22

Substitution of Gabapentin Therapy with Pregabalin Therapy in Neuropathic Pain

due to Peripheral Neuropathy.

Toth C.

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta,

Canada.

Abstract Objective. To determine the utility of substitution of pregabalin (PGB)

for gabapentin (GBP) therapy in the relief of neuropathic pain (NeP) in patients

with peripheral neuropathy (PN).

Design. A cohort study was performed examining PGB substitution in patients who

were GBP responders (>/=30% NeP relief on a visual analog scale [VAS]) or GBP

nonresponders after prolonged GBP use, with further comparison to patients

receiving continuous GBP therapy. Setting. Patients with PN and related NeP

requiring GBP therapy were evaluated in a tertiary care neurological clinic at

0, 6, and 12 months.

Outcome Measures. Pain severity (Visual Analog Score [VAS]) was the primary

outcome measure, while quality of life (European Quality of Life - 5 Domains

[EQ-5D] and EQ-5D VAS) and occurrence of adverse events were secondary outcome

measures. Results. Both GBP responder and nonresponder groups had additional NeP

relief of about 25% following substitution of PGB after 6 and 12 months, while

improved EQ-5D VAS was identified in the GBP nonresponder group.

There were no serious adverse events for either medication, while GBP

nonresponders discontinued PGB in more than 30% of cases due to inefficacy or

adverse events.

Conclusions. Randomized, controlled, blinded head-to-head studies of GBP and PGB

have not been published. The results of this open-label assessment of PGB

substitution for GBP suggest that PGB may provide additional pain relief and

possible improvement in quality of life above that received by GBP use in

patients with NeP due to PN.