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This study investigated the efficacy of the Lido-Patch (lidocaine 5% medicated plaster) in treatment of pain caused by PHN which is a neuropathic pain syndrome (nerve-related pain conditions) following an acute attack of herpes zoster (shingles).
Participants were treated up to 10 weeks in this study: an 8-week Run-in Phase of open-label treatment with Lido-Patch was followed by a 2-day to 14-day Double-blind Phase with Lido-Patch or Placebo Patch treatment. Only participants responding to open-label treatment with Lido-Patch were included in the Double-blind Phase. In a Follow-up Phase without treatment, the safety of participants was monitored for 1-2 weeks. Alternatively, patch application could be continued for up to 12 months in the clinical study KF10004/02.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lido-Patch (Open-label Run-in Phase) | Experimental | All participants applied up to 3 Lido-Patches (lidocaine 5% medicated plaster) per day (depending on the size of PHN area). Patches were applied topically for up to 12 hours per day (patch free interval: at least 12 hours) at the site of skin affected by painful PHN. |
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| Lido-Patch (Double-blind Phase) | Experimental | Up to 3 patches (lidocaine 5% medicated plaster) per day (depending on the size of PHN area) were applied topically for up to 12 hours per day (patch free interval: at least 12 hours) at the site of skin affected by painful PHN. |
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| Placebo Patch (Double-blind Phase) | Placebo Comparator | Up to 3 placebo plasters per day (depending on the size of PHN area) were applied topically for up to 12 hours per day (patch free interval: at least 12 hours) at the site of skin affected by painful PHN. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lidocaine 5% medicated Plaster | Drug |
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| Measure | Description | Time Frame |
|---|---|---|
| Time-to-exit in Double-blind Phase Due to Lack of Efficacy | The time to exit was defined as the number of days after randomization where worsening of the pain relief score by 2 or more categories on a 6-item pain relief scale (verbal rating scale, VRS) on 2 consecutive days in comparison to the average pain relief in Week 8 of the Run-in Phase was reported. The average pain relief in Week 8 of the enrichment phase was to be stated by the participant at the randomization visit. The VRS comprised the categories 1 = worse, 2 = no pain relief, 3 = slight, 4 = moderate, 5 = a lot, 6 = complete. | From Day 1 until time to exit in Double-blind Phase (maximum Day 14) |
| Measure | Description | Time Frame |
|---|---|---|
| Daily Pain Intensity: NRS | Pain intensity was assessed as "pain right now" directly before patch application and before patch removal, and as "24-hour average pain" before patch removal using an 11-point Numeric Rating Scale (NRS from 0 = no pain to 10 = pain as bad as you can imagine). | From screening visit (Week -1) to end of Double-blind Phase visit (Week 10) |
| Measure | Description | Time Frame |
|---|---|---|
| Chronic Pain Sleep Inventory (CPSI) | The CPSI is a 5-point verbal rating scale (VRS) designed to provide information on the influence of the pain on sleep quality with the items trouble falling asleep, needing sleep medication, and awakened by pain during the night/in the morning (categories of the VRS: never, rarely, sometimes, usually, always); in addition, the overall quality of sleep (categories of the VRS: poor, fair, good, very good, and excellent) was assessed. Participants were asked to complete the CPSI questionnaire at each visit. |
Inclusion Criteria for the Run-in Phase:
Randomization Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Grünenthal Study Director | Grünenthal GmbH | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19432499 | Result | Binder A, Bruxelle J, Rogers P, Hans G, Bosl I, Baron R. Topical 5% lidocaine (lignocaine) medicated plaster treatment for post-herpetic neuralgia: results of a double-blind, placebo-controlled, multinational efficacy and safety trial. Clin Drug Investig. 2009;29(6):393-408. doi: 10.2165/00044011-200929060-00003. |
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| ID | Term |
|---|---|
| D051474 | Neuralgia, Postherpetic |
| D006562 | Herpes Zoster |
| ID | Term |
|---|---|
| D009437 | Neuralgia |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D008012 | Lidocaine |
| C511998 | Lidoderm |
| ID | Term |
|---|---|
| D000083 | Acetanilides |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 |
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An enriched enrolment, randomized-withdrawal, parallel-group design was applied. Only participants responding to open-label active treatment were included into the Double-blind Phase.
The study comprised:
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Open-label enriched enrolment followed by double-blind treatment for 2 weeks.
| Placebo Plaster | Drug |
|
| Daily Pain Relief | Pain relief was defined as relief at the time point directly before patch removal in comparison to the time point directly before patch application. Pain relief was assessed using a 6-item relief scale (VRS) with categories 1 = worse, 2 = no pain relief, 3 = slight, 4 = moderate, 5 = a lot, and 6 = complete. | From screening visit (Week -1) to end of Double-blind Phase visit (Week 10) |
| Weekly Average 24-hour Pain Intensity: NRS | The weekly average of the 24-hour average pain intensity was calculated based on corresponding daily pain intensities over the last week before the respective visit. Pain intensities were assessed using an 11-point Numeric Rating Scale (NRS from 0 = no pain to 10 = pain as bad as you can imagine). | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-blind Phase) |
| Weekly Average Current Pain Intensity: NRS | The weekly average of the current pain ("pain right now") intensities before patch application or before patch removal were calculated based on corresponding daily pain intensities over the last week before the respective visit. Pain intensities were assessed using an 11-point Numeric Rating Scale (NRS from 0 = no pain to 10 = pain as bad as you can imagine). | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-blind Phase) |
| Weekly Average Pain Relief: VRS | The weekly average pain relief was calculated based on daily pain relief over the last week before visit. Pain relief was assessed using a 6-item relief scale (VRS) with categories 1 = worse, 2 = no pain relief, 3 = slight, 4 = moderate, 5 = a lot, and 6 = complete. | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-bind Phase) |
| Weekly Worst Pain Intensity: NRS | Weekly worst pain intensity was assessed in the last week before the visit using an 11-point NRS (from 0 = no pain to 10 = pain as bad as you can imagine). | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-blind Phase) |
| Weekly Average Pain Intensity: NRS | Weekly average pain intensity was assessed in the last week before the visit using an 11-point NRS (from 0 = no pain to 10 = pain as bad as you can imagine). | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-blind Phase) |
| Weekly Least Pain Intensity: NRS | Weekly least pain intensity was assessed in the last week before the respective visit using an 11-point NRS (from 0 = no pain to 10 = pain as bad as you can imagine). | During Run-in Phase (visits after 1 and 4 weeks), after 8 weeks, and after 10 weeks (Double-blind Phase) |
| From screening at each visit up to the final visit (Week 10) [6 time points in total] |
| Short Form McGill Pain Questionnaire (SF-MPQ) | The SF-MPQ includes 15 words (11 sensory, 4 affective). Each word or phrase is rated on a 4-point intensity scale (0 = none, 1 = mild, 2 = moderate, and 3 = severe). In addition, the 6-point Present Pain Intensity (PPI) rating (no pain, mild, discomforting, distressing, horrible, excruciating) is included as a visual analogue scale for rating pain intensity. | At screening visit (Week -1), randomization visit (Week 8), and final visit (Week 10) |
| Clinical Global Impression of Change (CGIC) | Investigators were to describe their global impression of change (CGIC), i.e., the overall impression of the change of the participant's condition by answering the question "Compared to the patient's condition at admission to the project, how much has he/she changed?" The verbal rating scale comprises the categories not assessed [0], very much improved [1], much improved [2], minimally improved [3], no change [4], minimally worse [5], much worse [6], and very much worse [7]. When assessing the overall impression, the investigator was to refer to the Run-in Phase only. | Withdrawal visit (end of Run-in Phase) or final visit (end of Double-blind Phase) |
| Short Form-36 Quality of Life Index (SF-36) | The Short Form 36 Quality of Life Index (SF-36 [Trade Mark]) standard version with a 4-week recall period was used as a self-assessment. Eleven questions were answered on binomial (Yes/No) or on 3-, 5-, or 6-point categorical scales to generate the 8 raw scales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, Mental Health). Higher values of the raw scales represent a better outcome. The raw scales were converted into a transformed scale (transformed scale = [(actual raw score - lowest possible raw score) / possible raw score range] x 100). | At screening visit (Week -1), randomization visit (Week 8), and final visit (Week 10) |
| Allodynia Assessment | Allodynia severity was rated using the following categorical scale: 0 = no pain or discomfort to touch; 1 = uncomfortable, but tolerable to touch; 2 = painful; 3 = extremely painful, participant cannot stand touching. The test was conducted by means of a brush (type N12). The painful PHN area was stroked with the brush and the intensity of allodynic pain was assessed. | From screening at each visit up to Week 10 (6 time points in total) |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D000073618 | Varicella Zoster Virus Infection |
| D006566 | Herpesviridae Infections |
| D004266 | DNA Virus Infections |
| D014777 | Virus Diseases |
| D007239 | Infections |
| Aniline Compounds |
| D000588 | Amines |