Experience and challenges presented by a multicenter crossover study of combination analgesic therapy for the treatment of painful HIV-associated polyneuropathies
Taylor Harrison, Sachiko Miyahara, Anthony Lee, Scott Evans, Barbara Bastow, David Simpson, Ian Gilron, Robert Dworkin, Eric S Daar, Linda Wieclaw, David B Clifford, ACTG A5252 Team, Jane Baum, Travis Behm, Laura Blair, William Royce Hardin, Mallory Harvey, Evan Kharasch, Justin McArthur, David Moody, Kimberly Scarsi, Holly Shaw, Katherine Shin, David Simpson, Elizabeth Smith, Tzu-min Yeh, Eric S Daar, Edward Lozano, Teresa Spitz, Judy Frain, Nagagopal Venna, Tracey Cho, Kathleen Nuffer, Susan Cahill, Robert Kalayjian, Ann Marie Anderson, Nina Lambert, Bruce Cohen, Beverly Putnam, Steven Johnson, Tanvir K Bell, Maria Laura Martinez, Taylor Harrison, Sachiko Miyahara, Anthony Lee, Scott Evans, Barbara Bastow, David Simpson, Ian Gilron, Robert Dworkin, Eric S Daar, Linda Wieclaw, David B Clifford, ACTG A5252 Team, Jane Baum, Travis Behm, Laura Blair, William Royce Hardin, Mallory Harvey, Evan Kharasch, Justin McArthur, David Moody, Kimberly Scarsi, Holly Shaw, Katherine Shin, David Simpson, Elizabeth Smith, Tzu-min Yeh, Eric S Daar, Edward Lozano, Teresa Spitz, Judy Frain, Nagagopal Venna, Tracey Cho, Kathleen Nuffer, Susan Cahill, Robert Kalayjian, Ann Marie Anderson, Nina Lambert, Bruce Cohen, Beverly Putnam, Steven Johnson, Tanvir K Bell, Maria Laura Martinez
Abstract
Objective: There is limited evidence for efficacy of analgesics as monotherapy for neuropathic pain associated with HIV-associated polyneuropathies, in spite of demonstrated efficacy in other neuropathic pain conditions. We evaluated the tolerability and analgesic efficacy of duloxetine, methadone, and the combination of duloxetine-methadone compared with placebo.
Design: This study was a phase II, randomized, double-blind, placebo-controlled, four-period crossover multicenter study of analgesic therapy for patients with at least moderate neuropathic pain due to HIV-associated polyneuropathy. Duloxetine, methadone, combination duloxetine-methadone, and placebo were administered in four different possible sequences. The primary outcome measure was mean pain intensity (MPI) measured daily in a study-supplied pain diary.
Results: A total of 15 patients were enrolled from eight study sites and eight patients completed the entire trial. Study treatments failed to show statistically significant change in MPI compared with placebo. Adverse events were frequent and associated with high rates of drug discontinuation and study dropout.
Conclusions: Challenges with participant recruitment and poor retention precluded trial completion to its planned targets, limiting our evaluation of the analgesic efficacy of the study treatments. Challenges to successful completion of this study and lessons learned are discussed.
Trial registration: ClinicalTrials.gov NCT00863057.
Keywords: Antidepressants; HIV; Neuropathic Pain; Opioids.
Conflict of interest statement
Conflict of Interest/Disclosure: Taylor Harrison: Funding support from the NINDS/NIH.
Sachiko Miyahara: Funding support from NINDS/NIH and NIAID/NIH.
Anthony Lee: Funding support from NIAID/NIH
Scott Evans: Funding support from NIAID/NIH
Barbara Bastow: No funding support for this project.
David Simpson: Funding support from NINDS/NIH.
Ian Gilron: No funding support for this project.
Robert Dworkin: No funding support for this project.
Eric Daar: Funding support from the NIAID and NIMH (NIH)
Linda Wieclaw: Funding support from the NIAID (NIH).
David Clifford: Funding support from NINDS and NIAID (NIH).
Wiley Periodicals, Inc.
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Source: PubMed