Results of a pooled analysis of 6 clinical trials found that dose escalation of pregabalin significantly improved pain outcomes in patients who had an inadequate response to therapy at a lower dose.

A total of 761 patients with neuropathic pain were divided into “dose pathway” groups, which were “based on their weekly pregabalin dose from the start of their trial to the first week of their maintenance phase.” The dose pathway groups were 150 mg/day only, 150 to 300 mg/day, 150 to 300 to 450 mg/day, 150 to 300 to 450 to 600 mg/day, 150 to 300 to 600 mg/day, and 300 to 600 mg/day. Pain outcomes were evaluated by determining the proportion of patients with a mean pain score reduction of ≥30% and ≥50% from baseline as well as by assessing the average change in pain score. 

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The study authors reported that a larger proportion of 30% and 50% responders were seen at each escalating dose in all dose pathway groups. Additionally, a greater change in pain score was also observed following dose escalation within each group. The authors also noted that “as assessed by the marginal structural model, higher doses of pregabalin were estimated to result in a significantly greater change in mean pain score at each week.”

For patients with an inadequate response to lower doses of pregabalin, dose escalation can lead to notable improvements in pain outcomes. Because of these results, the study authors “encourage physicians treating patients with neuropathic pain to escalate pregabalin to the dose that delivers optimal analgesia and tolerable side effects.”

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