Treatment of peripheral neuropathic pain by topical capsaicin: Impact of pre‐existing pain in the QUEPP‐study

Abstract

BackgroundThis study evaluates the impact of the duration of pre-existing peripheral neuropathic pain on the therapeutic response to the capsaicin 8% cutaneous patch.MethodsThe non-interventional QUEPP (QUTENZA – safety and effectiveness in peripheral neuropathic pain) study evaluated the effectiveness of Qutenza™ in 1044 non-diabetic patients with peripheral neuropathic pain, who received a single application. Follow-up visits were scheduled at weeks 1–2, 4, 8 and 12. A pre-defined co-analysis of changes in average pain intensity was performed based on the duration of pre-existing pain.ResultsIn patients with pre-existing pain for <6 months, the mean relative change of the numeric pain rating scale score on days 7–14 to week 12 versus baseline was −36.6% [4.6 standard error of the mean (SEM); n = 105], −25.1% (1.9 SEM; n = 311) in patients with pain duration of 6 months to 2 years, −22.3% (1.6 SEM; n = 391) in patients with pain for >2–10 years, and −19.2% (2.6 SEM; n = 99) in patients with pain for >10 years. Thirty percent and 50% responder rates were 61.7% and 39.3% in patients with pre-existing pain for <6 months, 42.3% and 23.3% in patients with pain for 6 months to 2 years, 40.9% and 21.6% in patients with pain for >2–10 years, and 32.3% and 14.1% in patients with pain for >10 years.ConclusionsThe highest treatment response to the capsaicin 8% cutaneous patch was observed in patients with a history of pre-existing peripheral neuropathic pain of less than 6 months, suggesting that early initiation of topical treatment might be indicated.

Presence of hyperalgesia predicts analgesic efficacy of topically applied capsaicin 8% in patients with peripheral neuropathic pain

“…In other pNP syndromes, ≥30% pain relief was achieved in only about 50% of patients . Only short disease durations, <6 months, predicted treatment response independently from the underlying diagnoses (Maihofner and Heskamp, 2013b). Only short disease durations, <6 months, predicted treatment response independently from the underlying diagnoses (Maihofner and Heskamp, 2013b).…”

“…Self-reported sensory symptoms failed to identify responders (Hoper et al, 2013). Only short disease durations, <6 months, predicted treatment response independently from the underlying diagnoses (Maihofner and Heskamp, 2013b). So far, other predictors for positive outcome remain unknown.…”

Predictors of Treatment Response to Capsaicin Patch

“…Three studies have found correlation with pain and response to treatment [26][27][28]. Although, the correlation is not the same, and the quality of pain investigated was different too.…”

“…At present, there are no reliable predictors of response to treatment with capsaicin for analgesia. There have been several studies that have tried to look for predictors of treatment response [26][27][28][29][30][31]. In this chapter we are going to comment on them trying to give more light into this issue.…”

Place du patch de capsaïcine à haute concentration (8 %) dans la stratégie thérapeutique des douleurs neuropathiques périphériques

“…Les résultats de cette étude confirment l'efficacité de Qutenza ® observée dans les essais cliniques, avec une réduction du score de douleur de -27 % dès la 2 e semaine et maintenue jusqu'à 3 mois et ce, quelle que soit l'étiologie. Une analyse [31] en sousgroupe selon l'ancienneté de la douleur a été effectuée et montre une meilleure efficacité du patch lors d'une prise en charge précoce (douleur évoluant depuis moins de 6 mois).…”