Pregabalin for painful HIV neuropathy

Simpson, David M.; Schifitto, Giovanni; Clifford, David B.; Murphy, T.K.; Cruz, E. Durso-De; Glue, Paul; Whalen, Ed; Emir, Birol; Scott, Gayle; Freeman, Roy

doi:10.1212/wnl.0b013e3181ccc6ef

Cited by 189 publications

(132 citation statements)

References 32 publications

(50 reference statements)

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“…[71][72][73][74][75][76][77] It is unclear whether these results reflect a true lack of efficacy in the specific conditions studied or whether other factors have accounted for the lack of success in demonstrating efficacy (eg, inadequate power to detect modest treatment benefits, excessive response rates in placebo groups, other methodological features of the trials).…”

Section: Negative Trials Of Pharmacological Treatments For Np and Thementioning

confidence: 99%

“…The first indication of this was the publication in 1998 of 2 placebo-controlled RCTs in which amitriptyline failed to relieve pain in patients with painful HIV neuropathy, 80,81 which has been followed by negative trials of topical lidocaine 82 and pregabalin 76 in HIV neuropathy. The results of a recent negative trial of memantine in HIV neuropathy 83 are more difficult to interpret because memantine is considered a third-line NP treatment on the basis of inconsistent evidence of efficacy.…”

Section: 79mentioning

confidence: 99%

See 1 more Smart Citation

Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update

Dworkin

O’Connor

Audette

et al. 2010

Mayo Clinic Proceedings

1,147

901

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The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel a 2 -d ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.Mayo Clin Proc. 2010;85(3)(suppl):S3-S14 DPN = diabetic peripheral neuropathy; HIV = human immunodeficiency virus; HRQoL = health-related quality of life; NeuPSIG = Neuropathic Pain Special Interest Group; NP = neuropathic pain; PHN = postherpetic neuralgia; RCT = randomized clinical trial; SSNRI = selective serotonin norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant

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Section: Negative Trials Of Pharmacological Treatments For Np and Thementioning

confidence: 99%

Section: 79mentioning

confidence: 99%

Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update

Dworkin

O’Connor

Audette

et al. 2010

Mayo Clinic Proceedings

1,147

901

View full text Add to dashboard Cite

show abstract

“…Subgroup analysis of a randomized controlled trial of pregabalin in HIV-SN has reported a small group of patients with signs of mechanical sensory gain [44]. Furthermore, by using the Neuropathic Pain Symptom Inventory it has been revealed that 42% of participants experiencing painful HIV-SN report symptoms of moderate and severe cold evoked pain, although this is not detected with sensory profiling [40].…”

Section: Systemic Indinavir Induces a Minimal Spinal Microglial Respomentioning

confidence: 99%

A rodent model of HIV protease inhibitor indinavir induced peripheral neuropathy

Huang

Calvo

Pheby

et al. 2016

Pain

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Abstract:HIV-associated sensory neuropathy (HIV-SN) is the most frequent manifestation of HIV disease. It often presents with significant neuropathic pain and is associated with previous exposure to neurotoxic nucleoside reverse transcriptase inhibitors. However, HIV-SN prevalence remains high even in resource-rich settings where these drugs are no longer used. Previous evidence suggests that exposure to indinavir, a protease inhibitor commonly used in antiretroviral therapy, may link to elevated HIV-SN risk.Here we investigated whether indinavir treatment was associated with the development of a "dying back" axonal neuropathy and changes in pain-relevant limb withdrawal and thigmotactic behaviours. Following two intravenous injections of indinavir (50 mg/kg, 4 days apart), adult rats developed hindpaw mechanical hypersensitivity, which peaked around 2 weeks post first injection (44% reduction from baseline). At this time, animals also had 1) significantly changed thigmotactic behaviour (62% reduction in central zone entries) comparing to the controls and 2) a significant reduction (45%) in hindpaw intraepidermal nerve fibre density. Treatment with gabapentin, but not amitriptyline, was associated with a complete attenuation of hindpaw mechanical hypersensitivity observed with indinavir treatment. Furthermore, we found a small but significant increase in microglia with the effector morphology in the lumbar spinal dorsal horn in indinavir-treated animals, coupled with significantly increased expression of phosphop38 in microglia. In summary, we have reported neuropathic pain-related sensory and behavioural changes accompanied by a significant loss of hindpaw skin sensory innervation in a rat model of indinavir-induced peripheral neuropathy that is suitable for further pathophysiological investigation and preclinical evaluation of novel analgesics. We are pleased to hear that you, the Section Editor, and the reviewer #1 have considered that our manuscript is suitable for publication in PAIN pending minor revisions. We have addressed the reviewer's minor concerns (highlighted in red color in the manuscript) as follows: Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation1. Concern 1: "The authors should indicate the concentrations of each antibodies they used." Response: We have included antibody concentrations in the result section as suggested by the reviewer (page 8, second paragraph; page 9, second paragraph).2. Concern 2: "There are also some spelling mistakes that need to be fix. For example, in the abstract: phospho-p38 instead of "phopspho-p38", p12 line 3-4 cold hypersensitivity instead of mechanical hypersensitivity." Response: We have corrected the spelling mistakes (page 2, line 16; page 12, line 3).We feel that the above changes have addressed the minor concerns of the reviewer. We thank you for considering our submission for publication in Pain.Yours Sincerely, Dr. Wenlong HuangResponse to Reviewers 1 Abstract HIV-associated sensory neuropathy (HIV-SN) is the most freque...

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“…A recently published review and meta-analysis describes randomized controlled trials (RCT`s) evidence of analgesic efficacy superior to placebo in the context of HIV-SN pain only for smoked cannabis, recombinant nerve growth factor (rhNGF) and high dose (8%) topical capsaicin [48]. Several other agents have been examined in RCTs and found to be not effective such as acetyl-L carnitine (1g/day), amitriptyline (100mg/day), topical capsaicin 0.075%, gabapentin (2.4g/day), mexilitine (600mg/day), peptide -T (6mg/day), pregabalin (600mg/day), lamotrigine (600mg/day) and prosaptide (16mg/day) [48, (Simpson, Schifitto et al 2010)]. Prospective RCT´s show however an effectiveness for gabapentin (up to 3.6g/d) [49] in HIV-DSP as well as lamotrigene in ATN [50].…”

Section: Wwwintechopencommentioning

confidence: 99%