Peripheral nerve stimulation (PNS) may be a viable treatment option for patients with facial trigeminal neuropathic pain (TNP), according to results of a systematic review and meta-analysis published in Neuromodulation.
Researchers from Central South University in China searched publication databases through October 2020 for studies of neuropathic pain and implantable neurostimulators. A total of 13 studies comprising 221 patients were included in the final analysis.
Patients were mostly women (59.7%) with TNP (85%). Other diagnoses included atypical trigeminal neuralgia, herpes zoster ophthalmicus, postherpetic neuralgia, persistent idiopathic facial pain, supraorbital neuralgia, symptomatic trigeminal neuralgia, trigeminal deafferentation pain, temporomandibular joint disorder, trigeminal neuralgia, and headache.
The response rate to PNS (pain relief of >50%) was 60.2% (95% CI, 41.9% to 76.1%; I2, 70.733%; P <.0001). Compared with baseline, PNS was associated with an improvement in pain scores of 2.363 (95% CI, 1.408-3.319; I2, 85.723%; P <.0001).
Stratified by subgroup, the response rates of the combined etiologies was 69.1% (95% CI, 42.8% to 87.0%; I2, 76.315%; P =.001) and among the TNP subgroup, the response rate was 47.0% (95% CI, 23.5% to 71.9%; I2, 62.160%; P =.048).
Stratified by PNS target, the response rate for gasserian ganglion stimulation was 29.3% (95% CI, 19.2% to 41.8%; I2, 0%; P =.635), 77.6% for peripheral branch stimulation (P <.0001), and 52.2% (95% CI, 32.5% to 71.2%; I2, 0%; P =1) for trigeminal nerve root stimulation.
Frequently reported adverse events included displacement of electrodes, infection, physical discomfort, surgical revision, and loss of efficacy.
This analysis was limited by the fact that no studies were of randomized designs, significant heterogeneity was observed, and the combined etiology group had few patients with multiple diagnoses.
The study authors concluded PNS may be a viable treatment option for patients with TNP, especially among patients who are not candidates for conventional therapies. Stimulation of the trigeminal peripheral branches may be more effective than stimulation of the gasserian ganglion. Additional randomized trials are needed.
Ni Y, Yang L, Han R, et al. Implantable peripheral nerve stimulation for trigeminal neuropathic pain: a systematic review and meta-analysis. Neuromodulation. Published online May 18, 2021. doi:10.1111/ner.13421
Rapid and sustained improvements in skin-specific systemic lupus erythematosus (SLE) were seen in patients with mild to severe baseline cutaneous activity who received anifrolumab, according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.
In the phase 3 TULIP-1 and TULIP-2 trials, a greater percentage of patients with SLE and a Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI-A) score of 10 or greater at baseline who received anifrolumab vs placebo achieved a 50% or greater disease severity reduction at week 12.
In the current study, the researchers sought to further evaluate the effects of anifrolumab on skin-specific SLE disease activity using pooled data from the TULIP-1 and TULIP-2 trials.
Data were pooled from both the 52-week, randomized, double-blind trials, and skin responses were compared between patients receiving anifrolumab and those receiving placebo. A CLASI-A response was defined as a 50% or greater reduction in CLASI-A score from baseline in patients with a baseline CLASI-A score of 10 or greater. A Cox proportional hazards model was used to evaluate time to CLASI-A response sustained to week 52.
In total, 360 patients with moderate to severe active SLE received 300 mg of intravenous anifrolumab every 4 weeks for 48 weeks, along with their standard-of-care treatment. A total of 366 patients received placebo. At baseline, 95.9% of the combined patient groups (n=696) had a CLASI-A score of greater than 0, and 27.7% (n=201) had a CLASI-A score of 10 or greater (balanced between groups). In the subgroup of patients with baseline CLASI-A score of 10 or greater, reduction of 50% of greater by week 12 was seen in 46.0% of patients (n=49) receiving anifrolumab vs 24.9% of those (n=24) receiving placebo (difference, 21.0; 95% CI, 8.1%-34.0%; nominal P <.001). Researchers recorded separation between treatment groups as early as week 8 (difference, 14.3; 95% CI, 1.8%-26.9%; nominal P <.02).
Patients who received anifrolumab showed sustained time to CLASI-A response to week 52 in the TULIP-1 (hazard ratio [HR], 1.91; 95% CI, 1.14-3.27) and TULIP-2 trial (HR, 1.55; 95% CI, 0.87-2.85). In the subgroup of patients with baseline CLASI-A scores greater than 0, more patients achieved a CLASI-A response of 50% or greater reduction by week 12 in the anifrolumab vs placebo groups in both the TULIP-1 and TULIP-2 trial (nominal P <.05). The subgroup of patients with baseline CLASI-A scores of 10 or greater in both the TULIP-1 and TULIP-2 trial demonstrated similar results (nominal P <.05).
Researchers concluded that their findings “support the potential of anifrolumab to reduce skin disease activity in patients with moderately to severely active SLE.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. The study was sponsored by AstraZeneca.
Werth V, Furie R, Morand E, et al. Early and sustained reduction in severity of skin disease with anifrolumab treatment in patients with active SLE measured by the cutaneous lupus erythematous disease area and severity index (CLASI): pooled data from 2 phase 3 studies. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0985.
This article originally appeared on Rheumatology Advisor