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Zalicus AŞ Message Board

  • trader33340 trader33340 Sep 18, 2013 9:05 AM Flag

    Question about placebo...

    Does anyone know what could be a placebo pill z160 is up against in the lsr trial?
    What other drugs, available on the market in form of pill and not opiod addictive, have ability to control the pain at this levels?
    Any thoughts appriaciated...

    Sentiment: Strong Buy

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    • The placebo is a sugar pill. The only medication for pain that trial participants can take is OTC Tylenol. As such, there will certainly be some dropouts; how many is the question.

    • mark_in_los_angeles_90049 mark_in_los_angeles_90049 Sep 18, 2013 10:08 AM Flag

      To the point of the question, none of the medications below could be used as placebo due to their expected medical effect against pain...where a placebo would be expected to have zero analgesic effect.

    • It's best to classify analgesics by category. For neuropathic pain, multiple classes exist. Radiculoopathy can be classified as neuropathic pain. Essentially, these agents are membrane stabilizers. The most commonly used medication for LSR is gabapentin (neurontin). Pregabalin (Lyrica) is derived from neurontin and is also widely used but more expensive. Zonegran came out some years ago but never was able to acquire a large market share (I haven't seen it prescribed in my community in years). The SNRI's (serotonin norepinephrine uptake inhibitors, including Effexor, Cymbalta, Pristiq) are second line agents that would be utilized in those who cannot tolerate neurontin or Lyrica. Tricyclic antidepressants have also been used for central pain, and occasionally cervial and lumbar radiculopathy in refractory cases, particularly at night (there is a common sedative effect) and for patients with failed back surgery. Nucynta (tapentadol) is a newer mediction that works partially like an opiate (narcotic) but is not classified as such. There is also some activity at the level of norepineprhine reutake. It is similar to tramadol, but more effective. In my experience it works well, but is expensive and hasn't gained a large market share yet. In my opinion, there is definitely room for a new neuropathic agent, if it has fewer side effects (sedation, lower extremity edema). Any alternate to opiates is attractive to physicians, as the medicolegal environment surrounding the narcotics has become difficult for physicians. If Z160 can make it to approval and holds up to promises regarding fewere side effects, there should be solid sales.