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Efficacy and Safety of 5% Lidocaine (Lignocaine) Medicated Plaster in Comparison with Pregabalin in Patients with Postherpetic Neuralgia and Diabetic Polyneuropathy

Interim Analysis from an Open-Label, Two-Stage Adaptive, Randomized, Controlled Trial

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Abstract

Background and objective: Postherpetic neuralgia (PHN) and diabetic polyneuropathy (DPN) are two common causes of peripheral neuropathic pain. Typical localized symptoms can include burning sensations or intermittent shooting or stabbing pains with or without allodynia. Evidence-based treatment guidelines recommend the 5% lidocaine (lignocaine) medicated plaster or pregabalin as first-line therapy for relief of peripheral neuropathic pain. This study aimed to compare 5% lidocaine medicated plaster treatment with pregabalin in patients with PHN and patients with DPN.

Methods: The study was a two-stage, adaptive, randomized, controlled, open-label, multicentre trial that incorporated a drug wash-out phase of up to 2 weeks prior to the start of the comparative phase. At the end of the enrolment phase, patients who fulfilled the eligibility criteria were randomized to either 5% lidocaine medicated plaster or pregabalin treatment and entered the 4-week comparative phase. The interim analysis represents the first stage of the two-stage adaptive trial design and was planned to include data from the comparative phase for the first 150 randomized patients of the 300 total planned for the trial. Patients aged ≥18 years with PHN or DPN were recruited from 53 investigational centres in 14 European countries. For this interim analysis, 55 patients with PHN and 91 with DPN (full-analysis set [FAS]), randomly assigned to the treatment groups, were available for analysis. Topical 5% lidocaine medicated plaster treatment was administered by patients to the area of most painful skin. A maximum of three or four plasters were applied for up to 12 hours within each 24-hour period in patients with PHN or DPN, respectively. Pregabalin capsules were administered orally, twice daily. The dose was titrated to effect: all patients received 150mg/day in the first week and 300 mg/day in the second week of treatment. After 1week at 300 mg/day, the dose of pregabalin was further increased to 600 mg/day in patients with high pain intensity scores. The pre-planned primary study endpoint was the rate of treatment responders, defined as completing patients experiencing a reduction from baseline of ≥2 points or an absolute value of ≥4 points on the 11-item numerical rating scale of recalled average pain intensity over the last 3 days (NRS-3), after 4 weeks of treatment. Secondary endpoints included ≥30% and ≥50% reductions in NRS-3 scores, changes in neuropathic pain symptom inventory (NPSI) scores and allodynia severity ratings.

Results: Overall, 65.3% of patients treated with the 5% lidocaine medicated plaster and 62.0% receiving pregabalin responded to treatment with respect to the primary endpoint. A higher proportion of PHN patients responded to plaster treatment compared with pregabalin (63.0% vs 37.5%), whereas in the larger DPN group treatments were comparable. Both treatments improved NPSI scores and reduced allodynia severity. Patients administering lidocaine plaster experienced fewer drug-related adverse events (3.9% vs 39.2%) and there were substantially fewer discontinuations due to drug-related adverse events (1.3% vs 20.3%).

Conclusion: After 4 weeks, 5% lidocaine medicated plaster treatment was associated with similar levels of analgesia in patients with PHN or DPN but substantially fewer frequent adverse events than pregabalin.

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Acknowledgements

The authors would like to thank the clinical investigators who took part in this study.

Ralf Baron has received honoraria from Allergan, Schwarz, Pfizer, Grünenthal, Sanofi-Pasteur and Genzyme and has received research funding from Pfizer, Grünenthal and Genzyme. Andreas Binder has received honoraria from Allergan, Schwarz, Pfizer and Grünenthal. Victor Mayoral has received honoraria from Grünenthal. Göran Leijon has no conflicts of interest that are relevant to the content of this study. Ilona Steigerwald is an employee of Grünenthal. Michael Serpell has received honoraria from Grünenthal, and his institution received remuneration from Grünenthal to cover the costs of patient visits and recruitment during the study.

Medical writing assistance was provided by Wolters Kluwer Health and was funded by Grünenthal.

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Authors and Affiliations

  1. Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 41, Arnold-Heller-Str. 3, 24105, Kiel, D-24105, Germany

    Ralf Baron & Andreas Binder

  2. Clínica del Dolor, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Victor Mayoral

  3. Department of Clinical and Experimental Medicine, Division of Neurology, University Hospital, Linköping, Sweden

    Göran Leijon

  4. Grünenthal GmbH, Aachen, Germany

    Ilona Steigerwald

  5. Pain Clinic, Gartnavel General Hospital, University of Glasgow, Glasgow, UK

    Michael Serpell

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  1. Ralf Baron
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  2. Victor Mayoral
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  4. Andreas Binder
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Correspondence to Ralf Baron.

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Baron, R., Mayoral, V., Leijon, G. et al. Efficacy and Safety of 5% Lidocaine (Lignocaine) Medicated Plaster in Comparison with Pregabalin in Patients with Postherpetic Neuralgia and Diabetic Polyneuropathy. Clin. Drug Investig. 29, 231–241 (2009). https://doi.org/10.2165/00044011-200929040-00002

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