Progressive Improvements with Repeated High-Concentration Capsaicin Patch: Real-World Data from the Retrospective CASPAR German Pain e-Registry Study in Postherpetic Neuralgia

Dermatology and Therapy, vol. 16, pp. 1125–1145

Abstract

Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that disproportionally affects older adults. First-line oral treatments often yield suboptimal relief and may cause systemic side effects and drug–drug interactions. Effective topical treatments offer the potential to address this significant unmet medical need in PHN. This CASPAR analysis evaluated real-world effectiveness and safety of the high-concentration capsaicin patch (HCCP) in patients with PHN. Real-world data were evaluated for a large PHN cohort extracted from the German Pain e-Registry as part of the retrospective, noninterventional, multicohort CASPAR study. Patients received one to four HCCP treatments over 12 months. Patient-reported outcomes included average pain intensity (API), quality of life (QoL), sleep impairment, mood, concurrent pain medications, and safety. This analysis included 961 patients with PHN (mean age: 63.8 years, female: 69.7%; mean pain duration: 3.3 years) receiving one (n = 187), two (n = 209), three (n = 207), or four HCCP treatments (n = 358). Mean 24-h API decreased from 61.8 at baseline to 46.8 by month 3 (P < 0.001), and to 31.8 at month 12 (P < 0.001). Patients receiving four treatments had the greatest API reductions (63.7 at baseline versus 19.6 at month 12; P < 0.001), whereas improvements were lost in those who discontinued treatment. While ≥ 30% API response rates were similar across treatment groups at month 3 (25.6–30.7% of patients), those receiving additional treatments showed continued improvement, peaking at 99.7% by month 12 after four HCCP treatments. Trends were similar for other patient-reported outcomes, including QoL, sleep, and mood. Concomitant pain medication use decreased over time. Most adverse drug reactions were mild and application site-specific. HCCP is an effective and well-tolerated topical treatment for patients with PHN, including older adults. After one treatment, improvements were noted in API, QoL, sleep, and mood outcomes, alongside decreased concomitant pain medication use, with progressive improvements following additional treatments. A Graphical Abstract is available for this article. Postherpetic neuralgia (PHN) is a long-lasting pain condition that can develop after a shingles infection and often affects older adults. The pain from PHN is debilitating and can significantly reduce patients’ quality of life. Many people with PHN do not experience adequate pain relief from oral medications and often experience side effects. The CASPAR study in Germany looked back at routine clinical records of patients with neuropathic pain. They were treated with a patch that delivers a high concentration (8%) of capsaicin (a naturally occurring compound found in hot chili peppers) directly into the skin. Capsaicin acts directly on the nerve endings that cause pain to help reduce symptoms. We investigated the effectiveness and safety of this treatment in patients with PHN who had between one and four capsaicin patch treatments over 1 year. In a total of 961 patients, pain reduced significantly, and additional improvements in sleep, mood, and quality of life were noted after just one treatment with the capsaicin patch. These improvements continued to increase with additional treatments. Patients who stopped treatment lost these effects over time. Side effects from treatment with the capsaicin patch were mostly short term and mild, typically on the area where the patch was applied, including sensations such as burning and itching. In conclusion, our study supports the use of the high-concentration capsaicin patch for managing PHN. The capsaicin patch can effectively reduce pain and showed further improvements in pain and overall wellbeing and reductions in the use of other pain medications with repeated treatments.

Authors 8

1. Sonja Ständer

   University of Münster · University Hospital Münster

   Affiliation as printed

   Section Pruritus Medicine, Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany

2. Mariëlle Eerdekens corresponding Aachen Grünenthal GmbH

   Grünenthal Group (Germany)

   Affiliation as printed

   Grünenthal GmbH, Global Medical Affairs, Aachen, Germany. marielle.eerdekens@grunenthal.com

3. Lucia Garcia-Guerra

   Grunenthal (Spain)

   Affiliation as printed

   Grünenthal Pharma S.A., Medical Affairs IBERIA, Madrid, Spain

4. Fabienne Percot
   Affiliation as printed

   Grünenthal Pharma S.A.S, Medical Affairs GALLIA, Puteaux, France

5. Samuel Allen
   Affiliation as printed

   Averitas Pharma, US Medical Affairs, Morristown, NJ, USA

6. Rita Freitas

   Grünenthal (Portugal)

   Affiliation as printed

   Grünenthal S.A., Global Market Access, Lisbon, Portugal

7. Tamara Quandel Aachen Grünenthal GmbH

   Grünenthal Group (Germany)

   Affiliation as printed

   Grünenthal GmbH, Medical Affairs DACH, Aachen, Germany

8. Michael A. Überall
   Affiliation as printed

   Institute of Neurological Sciences, Nürnberg, Germany