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 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.
To read this article in full you will need to make a payment
© 2017 Published by Elsevier Inc.