Postherpetic Neuralgia | Treatment Algorithms | Claims Data Analysis | US | 2014

Postherpetic neuralgia (PHN) is a chronic pain condition that requires prolonged treatment; this condition affected less than 246,000 people in the United States in 2013. Despite the modest size of the patient population, PHN has served—and continues to serve—as a gateway indication into the broader neuropathic pain (NP) market because, according to pain specialists interviewed by Decision Resources, PHN patients are relatively easy to diagnose, are fairly homogenous (i.e., they often do not suffer from forms of pain with mixed neuropathic/inflammatory components), and are reasonably responsive to treatment compared with other NP populations. Nevertheless, given the highly variable responses of PHN patients to different drugs typically prescribed to treat PHN, no standard treatment algorithm exists; thus, treatment is often tailored to meet patient-specific needs and generally includes use of a number of therapeutic agents from several drug classes.

Treatment guidelines for NP, and PHN specifically, indicate that antidepressants (e.g., amitriptyline [generics], duloxetine [Eli Lilly’s Cymbalta, generics]), pregabalin (Pfizer’s Lyrica), gabapentin (Pfizer’s Neurontin, generics), opioid analgesics, tramadol (Janssen’s Ultram/Ultram ER, other brands, generics), and the 5% lidocaine patch (Endo Pharmaceuticals’ Lidoderm, generics) are recommended for early lines of therapy. Using national patient-level claims data, this report explores the use of key therapies and drug classes in the newly diagnosed and recently treated PHN patient populations. Among the newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. Among recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by therapy.