NEJM: Lyrica ineffective in sciatica
- Australian researchers have found that Pfizer's Lyrica (pregabalin) is no better than placebo at fighting the pain caused by sciatica. The study looked at more than 200 patients with sciatica who were treated for up to eight weeks, and whose leg pain scored around 6 on a scale of one to ten.
- After eight weeks, the mean unadjusted leg-pain intensity score was 3.7 in the people receiving Lyrica as compared to 3.1 in the placebo group (p=0.19), and then a score of 3.4 for Lyrica and 3.0 for placebo (p=0.46) after one year. There were no material differences in the secondary endpoints — disability, back pain and quality of life — between Lyrica and placebo patients, either.
- According to the study presented in the New England Journal of Medicine, the side effects were worse in the Lyrica group as compared to the placebo group — 227 adverse reports versus 124, respectively — and while none were serious, the side effect of dizziness was more common in Lyrica than the placebo.
Sciatica pain, caused by compression of the sciatic nerve, can range from a niggling discomfort in the buttock to sharp pains, weakness and numbness down the leg. While sciatica is unlikely to cause permanent nerve damage, and resolves itself in most people over a few weeks or months, it can be tedious and is often treated with prescription or over-the-counter NSAIDs.
Lyrica was originally approved for epilepsy, and has since proved effective in a wide range of different types of pain. A majority of the drug's $5 billion annual sales are now for pain and approved pain indications include fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain and post-shingles pain. The drug is also used for pain relief off-label, and Australian data suggests that 14% of prescriptions are for people with sciatica.
If Lyrica had proved effective in sciatica, which effects up to 40% of people in their lifetime, it could have provided a bonus for Pfizer, which is likely to face generic competition in the U.S. in 2018. Generic forms of Lyrica are already available in the U.K. for epilepsy but not yet for pain.
- New England Journal of Medicine Trial of Pregabalin for Acute and Chronic Sciatica
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