As part of the ongoing argument about the efficiency of pregabalin (Lyrica) for treating neuropathic pain symptoms, today's post from pulsetoday.co.uk (see link below) examines the decision by NICE (the British National Institute for Health and Care) to backtrack on its plans to relegate pregabalin to a second drug of choice (behind gabapentin) in the treatment of neuropathic pain. Apart from the fact that gabapentin is cheaper than pregabalin, the ongoing controversies surrounding pregabalin (effectiveness and side effects issues) have led more and more doctors to prescribe gabapentin first. People with HIV and/or diabetes plus neuropathy should also be aware that Pfizer (the makers) have withdrawn their support (May 2012) for their own drug relating to those diseases because it has never been proved to work effectively for those groups and the law suits thanks to unpleasant side effects have brought yet more discredit on pregabalin as a treatment option. The best advice is to talk it over with your doctor or specialist but you may need to take further evidence with you if you're worried about taking pregabalin (Lyrica) because many doctors are still unaware of Pfizer's own policy. Many more articles about this drug can be found in the alphabetical list to the right of this blog.
NICE backs down on pregabalin restriction for neuropathic pain
22 November 2013 | By Caroline Price
NICE has back-tracked on controversial plans to demote pregabalin to second-line use after gabapentin in the management of neuropathic pain, it revealed in updated guidance released this week.
GPs can now offer either pregabalin, gabapentin, amitriptyline or duloxetine as initial treatment in patients with any type of neuropathic pain, with the exception of trigeminal neuralgia for which carbamazepine is the recommended initial treatment.
The decision marks an apparent climb-down by the regulator after it previously announced plans to switch pregabalin for gabapentin as a recommended first-line treatment on the grounds of cost.
NICE initially recommended amitriptyline or pregabalin first-line in treatment options in its first-ever guidance on pharmacological management of neuropathic pain published in 2010, with duloxetine recommended first-line for patients with painful diabetic neuropathy.
But within 18 months it announced a review of the decision on pregabalin, because of cost concerns – and proposed swapping gabapentin as an alternative first-line drug of choice.
However, the newly published final guidance reverses that proposal and leaves the choice down to GPs, with advice on what to try if the initial treatment is ineffective or not tolerated.
Dr Ollie Hart, a GPSI in pain in Sheffield, said the guidance was welcome and would reflect common practice, although he said most GPs would choose gabapentin before pregabalin because of the cost.
He told Pulse: ‘It reflects common practice where often clinicians rotate medications in a trial of “n=1” with the individual patient, with regular review of effects.
‘Most GPs would (and I would recommend) using gabapentin before pregabalin. Cost/value issue make this the sensible decision for most.’
Dr Hart said more detail would have been useful on how long initial treatments should be tried and it was disappointing the off-licence status of cheaper drugs has been highlighted in the guidance.
He said: ‘It would have been more helpful if they had indicated time frames for trailing meds - in reality I often allow two-to-four weeks for evidence of benefit or not.
‘It is a shame that they have chosen to highlight the off-licence aspects of some of the medications- amitriptyline for example has a long a well evidenced history of use in neuropathic pain. We are working in an NHS system where value based decisions have to be made,’ Dr Hart added.
http://www.pulsetoday.co.uk/clinical/therapy-areas/pain-relief/nice-backs-down-on-pregabalin-restriction-for-neuropathic-pain/20005139.article#.UsaDDbRhOSo
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