Mirogabalin vs pregabalin for chemotherapy-induced peripheral neuropathy in pancreatic cancer patients

Abstract

Background The prognosis of pancreatic cancer (PC) has been improved by new chemotherapy regimens (combination of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) or gemcitabine plus nab-paclitaxel (GnP)). Unfortunately, chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event of these two regimens. The efficacy of pregabalin for CIPN has been reported in previous studies. However, the efficacy of mirogabalin for CIPN remains unknown. Thus, in this study, we aimed to clarify which drug (mirogabalin or pregabalin) was more valuable for improving CIPN. Methods A total of 163 PC patients who underwent FOLFIRINOX or GnP between May 2014 and January 2021 were enrolled. Among them, 34 patients were diagnosed with CIPN. Thirteen patients were treated with mirogabalin (mirogabalin group), and twenty-one patients were treated with pregabalin (pregabalin group). Treatment efficacy was compared between the two groups. Results In both the mirogabalin group and the pregabalin group, the grade of patients with CIPN at 2, 4, and 6 weeks after the initiation of treatment showed significant improvement compared to the pretreatment grade. Notably, the rate of CIPN improvement was higher in the mirogabalin group than in the pregabalin group (2 weeks: 84.6% (11/13) vs 33.3% (7/21), P value = 0.005; 4 weeks, 6 weeks: 92.3% (12/13) vs 33.3% (7/21), P value = 0.001). Conclusions Although both mirogabalin and pregabalin were effective at improving CIPN, mirogabalin might be a suitable first choice for CIPN in PC patients. Trial registration Not applicable

Pregabalin Silences Oxaliplatin-Activated Sensory Neurons to Relieve Cold Allodynia

“…Pregabalin is a well-known anti-epileptic and analgesic drug that has been one of the staples in the treatment of neuropathic pain for years. Pregabalin was effective in ameliorating CIPN in numerous clinical trials of cancer-related neuropathic pain and allodynia after treatments with vincristine, paclitaxel, and drug cocktails comprising oxaliplatin (Atreya, 2016;Avan et al, 2018;Mishra et al, 2012;Sugimoto et al, 2021). However, data regarding its effectiveness in the treatment of cold allodynia are more controversial: earlier clinical trials and case studies found clear effectiveness of pregabalin to treat oxaliplatin-dependent neuropathy, whereas a more recent double-blinded trial found no significant difference from placebo on oxaliplatin-dependent CIPN, and ASCO guidelines do not fully recommend the use of gabapentinoids to treat CIPN (de Andrade et al, 2017;Loprinzi et al, 2020;SAIF et al, 2010).…”

Mirogabalin - the use of a new gabapentinoid in the treatment of diabetic neuropathy and postherpetic neuropathy and other conditions

“…Oszacowano, że po upływie 1 roku ból nadal występuje u 3% pacjentów. W leczeniu objawowym pierwszego rzutu stosuje się: doustne trójcykliczne leki przeciwdepresyjne, pregabalinę, opioidy oraz miejscowo lidokainę 5%, kapsaicyne [18]. Kato i współpracownicy w 2019 r. zbadali skuteczność oraz bezpieczeństwo mirogabaliny w leczeniu neuralgii popółpaścowej.…”

“…Przeprowadzono również badanie, w którym zastosowano mirogabalinę jako koanalgetyk w bólach przebijających w chorobie nowotworowej. Okazała się ona skuteczna u 88,2% pacjentów [18]. Nie wykazano korzystnego działania w zwalczaniu bólu w przebiegu fibromialgii [24].…”

Drug treatment for chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer

“…Previously, mirogabalin was used for diabetes-related peripheral neuropathy 61) . We have reported on the efficacy of mirogabalin for CIPN in PC patients 62) . In the study, 163 PC patients received FOLFIRINOX or GnP therapy.…”