Premedication with duloxetine reduces pain associated with Herpes Zoster
Postherpetic neuralgia (PHN) is the most complication of herpes zoster (HZ). This common chronic condition results in severe refractory neuropathic pain.
A study published in Clinical Infectious Diseases found that premedication with duloxetine may reduce the pain associated with Herpes Zoster.
This study evaluated the efficacy of premedication with duloxetine, preventing Postherpetic neuralgia.
The PROCESS trial is a randomized, open-label, multicenter study that enrolled adults aged 50 or older with HZ who presented with vesicles within 72 hours. The primary outcome was PHN incidence at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the VAS at week 12 following rash onset. The secondary outcomes included number of participants with VAS >0 and VAS ≥3. The primary outcome analysis used the modified intention-to-treat (mITT) and per-protocol (PP) principles.
Key findings from the study are:
- Duloxetin and the control group had 375 participants each.
- There was no significant difference in the PHN incidence in the duloxetine group than the control group in the mITT analysis (86 of 375 vs 108 of 375).
- PP analysis produced similar results.
- The two groups had significant differences in the numbers of participants with VAS >0 and VAS ≥3.
Concluding further, they said that though absolute prevention of PHN does not occur, this study found that premedication with duloxetine can reduce Herpes zoster associated pain. Therefore, it can have clinically relevant benefits.
Reference:
Chunmei Zhao et al. PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation—A Randomized Controlled Trial, Clinical Infectious Diseases, 2023.
