Herpes Zoster Clinical Trial
Official title:
Placebo-Controlled Study of Pregabalin for the Pain of Acute Herpes Zoster
The purpose of this study is to see if therapy with the drug pregabalin relieves pain during shingles compared with placebo. A placebo is an inactive substance. Pregabalin is a drug marketed as Lyrica™ in the United States for the treatment of seizures, diabetic neuropathy, and post-herpetic neuralgia. The use of pregabalin and drugs like it for the treatment of pain during the acute phase of shingles is experimental. Thirty four subjects will complete the study at the University of California, San Francisco (UCSF) Pain Clinical Research Center. This study is funded by Pfizer Global Research.
The varicella zoster virus (VZV) is the smallest of the double-stranded DNA herpes viruses,
and the only one capable of producing two different diseases, varicella (chickenpox) and
herpes zoster (acute herpes zoster [AHZ], shingles). The incidence of AHZ, and the secondary
VZV infection, is strongly age-dependent and reaches 1% per year by age 80 and there are
between 300,000 and 1 million new cases of AHZ each year in the US. AHZ is almost always
painful, and the pain can be of disabling severity, rendering some sufferers bed-bound and
too incapacitated to carry out normal activities, leading to weight loss and dehydration
sufficient to require inpatient therapy. The elderly are especially likely to suffer severe
pain.
The most common complication of AHZ is development of postherpetic neuralgia (PHN). Although
the overall incidence of PHN after AHZ is about 10%, the incidence has been reported to rise
as high as 80% in those over the age of 80. In all published studies, age and greater
severity of initial zoster pain are each found to significantly increase the risk of
developing PHN. Severe zoster pain is believed to correlate with a more severe cutaneous
outbreak, more severe inflammation of the nerve trunk, and possibly greater injury to
primary afferent nerve fibers.
There are two separate issues to address when discussing the pain of AHZ. The first is
managing the AHZ pain itself, because the burden of suffering is so high. The second is
reducing the incidence of PHN. Both issues need to be considered in trial design, in part
because severe AHZ pain is itself a risk factor for PHN. Studies of the analgesic effect of
pregabalin suggest an analgesic profile similar to that of gabapentin. We would therefore
predict, that pregabalin would reduce the pain associated with AHZ and possibly prevent
development of PHN.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double-Blind, Primary Purpose: Treatment
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