(378) Trigeminal neuralgia: pharmacotherapy and surgical treatment patterns in the United States

      Trigeminal neuralgia (TN) is a rare orofacial pain condition characterized by severe, unilateral, paroxysmal pain in the region of the trigeminal nerve. Clinical guidelines recommend carbamazepine (the only drug FDA-approved for TN) and oxcarbazepine as first-line therapies. Evidence for effectiveness of other pharmacotherapies, anesthetic/botulinum toxin injections, or neurosurgical procedures in TN is limited. We examined treatment patterns among a cohort of TN patients from the US TruvenHealth MarketScan® database. Patients included were aged ≥18 years, newly-diagnosed with TN (≥2 TN diagnoses ≥14 days apart, no diagnosis in prior year), and had ≥3 years’ follow-up after first TN diagnosis. Utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, and topiramate) or procedures (includes anesthetic/botulinum toxin injections and neurosurgical procedures) for TN was assessed. A total of 3685 patients were included (2425 commercial, 1260 Medicare enrollees; 72% female, mean[SD] age 59[15] years). Overall, 76% received ≥1 treatment regimen (studied pharmacotherapy [monotherapy/combination] or procedure) in the 3 years after diagnosis, of whom 65% received ≥2 and 45% ≥3 unique regimens (defined by a change in pharmacotherapy or a procedure). 72% received ≥1 studied pharmacotherapy; most commonly carbamazepine (38% of patients), gabapentin (35%), pregabalin (17%), or oxcarbazepine (15%). 18% underwent procedures; of these patients, 70% received further medications after the first procedure. Our study indicates that a variety of treatments are used for TN in the US, despite carbamazepine being the only approved medication. Almost half of treated patients receive ≥3 unique regimens within 3 years after initial diagnosis, suggesting frequent switching of therapy potentially due to suboptimal efficacy/tolerability. A substantial proportion utilize invasive procedures, with the majority of these patients requiring further treatments. Overall these data indicate a high burden-of-illness associated with TN and its treatment, and unmet needs with current therapies. This study was sponsored by Biogen.