Safety and Efficacy of Gabapentin in Postherpetic Neuralgia

A Phase 3 Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Gabapentin Extended Release (G-ER) Tablets in the Treatment of Patients With Postherpetic Neuralgia

Gabapentin and pregabalin are treatments for some types of neuropathic pain, including postherpetic neuralgia (PHN). However, these treatments usually need to be taken 3 times a day for effective pain control. The purpose of this study is to determine whether a new gabapentin tablet, which only needs to be taken once a day, is safe and effective for the treatment of postherpetic neuralgia.

Study Overview

• Status: Completed
• Conditions: Neuralgia,Postherpetic
• Intervention / Treatment: Drug: Gabapentin Extended Release tablets; Drug: Placebo

Detailed Description

The primary study objective is to assess the relative efficacy of G-ER dosed once daily (1800 mg following the evening meal), versus placebo in reducing the mean daily pain score from the baseline week to the end of the efficacy treatment period (Treatment Week 10) in patients with PHN.

Secondary efficacy measures will include changes from baseline in mean weekly sleep interference scores, Short-Form McGill Pain Questionnaire (SF-MPQ), the Neuropathic Pain Scale (NPS), Brief Pain Inventory (BPI), Patient Global Impression of Change (PGIC), and Investigator-Rated Clinical Global Impression of Change (CGIC).

• Study Type: Interventional
• Enrollment (Actual): 452
• Phase: Phase 3

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina
• Russian Federation
  • All over Russia, Russian Federation
  • St. Petersburg, Russian Federation
• United States
  • Alabama
    • Birmingham, Alabama, United States
    • Tuscaloosa, Alabama, United States
  • Arizona
    • Phoenix, Arizona, United States
  • Arkansas
    • Little Rock, Arkansas, United States
  • California
    • Lancaster, California, United States
    • Los Angeles, California, United States
    • Pismo Beach, California, United States
  • Colorado
    • Colorado Springs, Colorado, United States
    • Pueblo, Colorado, United States
  • Florida
    • Daytona Beach, Florida, United States
    • Naples, Florida, United States
    • New Port Richey, Florida, United States
    • Orlando, Florida, United States
    • Tampa, Florida, United States
  • Georgia
    • Marietta, Georgia, United States
  • Hawaii
    • Honolulu, Hawaii, United States
  • Illinois
    • Elk Grove Village, Illinois, United States
  • Louisiana
    • Shreveport, Louisiana, United States
  • Massachusetts
    • West Yarmouth, Massachusetts, United States
  • Michigan
    • Ann Arbor, Michigan, United States
  • Missouri
    • Florissant, Missouri, United States
    • Jefferson City, Missouri, United States
  • New Mexico
    • Albuquerque, New Mexico, United States
  • North Carolina
    • High Point, North Carolina, United States
  • North Dakota
    • Bismarck, North Dakota, United States
    • Fargo, North Dakota, United States
  • Ohio
    • Canton, Ohio, United States
    • Cincinnati, Ohio, United States
    • Kettering, Ohio, United States
  • Rhode Island
    • Warwick, Rhode Island, United States
  • South Carolina
    • Murrells Inlet, South Carolina, United States
    • Pelzer, South Carolina, United States
  • Tennessee
    • Tullahoma, Tennessee, United States
  • Texas
    • Austin, Texas, United States
    • Longview, Texas, United States
  • Washington
    • Spokane, Washington, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Men or women 18 years or older who have experienced pain for at least 6 months, but not more than 5 years after the healing of a herpes zoster skin rash(typically about 4 months after the rash first appears).
2. Patient has a pain intensity score of at least 4 on the 11-point Numerical Rating Scale (NRS). Patients should never be informed of the pain intensity criterion prior to screening or randomization.
3. Patients of child-bearing potential must have a negative serum pregnancy test at screening and a negative follow-up urine pregnancy test at randomization.
4. Patient has a mean baseline week pain intensity score of at least 4 on the 11-point NRS scale at the end of a 1-week baseline period and has completed at least 4 days of daily pain diary entries during the baseline week.
5. Patients must have a minimum washout period of greater than 5 times the half-life of the drug of several medications.
6. Patients currently treated with gabapentin pr pregabalin at screening may be eligible for the study, but must have a tapering period wherein the dose of gabapentin or pregabalin is reduced gradually over a period of 5 days followed by a two day washout prior to the Baseline Week.

Exclusion Criteria:

1. Patients who have previously not responded to treatment for PHN with gabapentin or pregabalin.
2. Patients who previously experienced dose-limiting adverse effects that prevented titration of gabapentin to an effective dose.
3. Patient is a nursing mother.
4. Patient has hypersensitivity to gabapentin.
5. Patient has had neurolytic or neurosurgical treatment for PHN.
6. Patient has severe pain from causes other than PHN.
7. Patient has used injected anesthetics or steroids within 30 days of baseline.
8. Patient has skin conditions in the area affected by the neuropathy that could alter sensation.
9. Patient is in an immunocompromised state.
10. Patient has an estimated creatinine clearance less than 50 ml/min.
11. Patient has had malignancy within past 2 years other than basal cell carcinoma.
12. Patient has had gastric reduction surgery.
13. Patient has severe chronic diarrhea, chronic constipation [unless attributed to drugs that will be washed out], uncontrolled irritable bowel syndrome (IBS) or unexplained weight loss.
14. Patient has any abnormal chemistry or hematology results that are deemed by the investigator to be clinically significant.
15. Patient has a history of substance abuse within the past year.
16. Patient has a history of seizure (except for infantile febrile seizure) or is at risk of seizure due to head trauma.
17. Patient has a history of chronic hepatitis B or C, hepatitis within the past 3 months, or HIV infection.
18. Patient has any other clinically significant medical or psychological condition that, in the opinion of the Investigator would jeopardize the safety of the patient or affect the validity of the study results.
19. Continuing use of any concomitant medication excluded by Inclusion Criterion 5.
20. Patient has participated in a clinical trial of an investigational drug or device within 30 days of the screening visit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo; Sugar pill	Drug: Placebo; Once daily; 300 mg and 600 mg tablets
Experimental: G-ER; Gabapentin - Extended Release	Drug: Gabapentin Extended Release tablets; Once-Daily; 300 mg and 600 mg tablets

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Baseline Observation Carried Forward (BOCF) Average Daily Pain Score	Average daily pain scored on 11-point numerical rating scale (where 0 = no pain, 10 = worst possible pain). Results presented as least squares (LS) mean change in baseline observation carried forward (BOCF) average daily pain score from baseline to the final week of efficacy treatment period (Week 10).	10 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Global Impression of Change (PGIC)	Patient self-assessment of how much pain had changed at end of treatment period (Week 10) compared to pain at baseline; scored on 7-point numerical rating scale (where 1 = very much improved, 7 = very much worse). Results presented as number of participants categorized at end of treatment (Week 10) as "very much improved" (score = 1) or "much improved" (score = 2).	10 weeks
Clinical Global Impression of Change (CGIC)	Investigator assessment of patient's overall PHN symptoms at end of treatment period (Week 10) compared to overall PHN symptoms at baseline; scored on 7-point numerical rating scale (where 1 = very much improved, 7 = very much worse). Results presented as number of participants categorized at end of treatment (Week 10) as "very much improved" (score = 1) or "much improved" (score = 2).	10 weeks
Average Daily Sleep Interference Score	Assessed on 11-point numeric rating scale (where 0 = pain does not interfere with sleep, 10 = pain completely interferes with sleep); evaluated from daily sleep entry in electronic diary. Results presented as least squares (LS) mean change in baseline observation carried forward (BOCF) average daily sleep interference score from baseline to final week of treatment period (Week 10).	10 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Last Observation Carried Forward (LOCF) Average Daily Pain Score	Average daily pain scored on 11-point numerical rating scale (where 0 = no pain, 10 = worst possible pain). Results presented as least squares (LS) mean change in last observation carried forward (LOCF) average daily pain score from baseline to final week of efficacy treatment period (Week 10).	10 weeks

Collaborators and Investigators

• Sponsor: Depomed

Publications and helpful links

General Publications

• Mehta N, Bucior I, Bujanover S, Shah R, Gulati A. Relationship between pain relief, reduction in pain-associated sleep interference, and overall impression of improvement in patients with postherpetic neuralgia treated with extended-release gabapentin. Health Qual Life Outcomes. 2016 Apr 1;14:54. doi: 10.1186/s12955-016-0456-0.

Study record dates

Study Major Dates

• Study Start: March 1, 2008
• Primary Completion (Actual): August 1, 2009
• Study Completion (Actual): September 1, 2009

Study Registration Dates

• First Submitted: February 21, 2008
• First Submitted That Met QC Criteria: March 13, 2008
• First Posted (Estimate): March 14, 2008

Study Record Updates

• Last Update Posted (Estimate): February 22, 2012
• Last Update Submitted That Met QC Criteria: February 21, 2012
• Last Verified: February 1, 2012

More Information

Terms related to this study

• Keywords: Postherpetic Neuralgia (PHN), shingles
• Additional Relevant MeSH Terms: Nervous System Diseases; Pain; Neurologic Manifestations; Neuromuscular Diseases; Peripheral Nervous System Diseases; Neuralgia; Neuralgia, Postherpetic; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Tranquilizing Agents; Psychotropic Drugs; Anti-Anxiety Agents; Anticonvulsants; Antimanic Agents; Gabapentin
• Other Study ID Numbers: 81-0062