Lamotrigine for HIV-associated painful sensory neuropathies: a placebo-controlled trial.
OBJECTIVE
To evaluate the efficacy and tolerability of lamotrigine (LTG) for the treatment of pain in HIV-associated sensory neuropathies.


METHODS
In a randomized, double-blind study, patients with HIV-associated distal sensory polyneuropathy (DSP) received LTG or placebo during a 7-week dose escalation phase followed by a 4-week maintenance phase. Randomization was stratified according to whether or not patients were currently using neurotoxic antiretroviral therapy (ART).


RESULTS
The number of patients randomized was 92 (62 LTG, 30 placebo) in the stratum receiving neurotoxic ART and 135 (88 LTG, 47 placebo) in the stratum not receiving neurotoxic ART. Mean change from baseline in Gracely Pain Scale score for average pain was not different between LTG and placebo at the end of the maintenance phase in either stratum, but the slope of the change in Gracely Pain Scale score for average pain reflected greater improvement with LTG than with placebo in the stratum receiving neurotoxic ART (p = 0.004), as did the mean change from baseline scores on the Visual Analogue Scale for Pain Intensity and the McGill Pain Assessment Scale and patient and clinician ratings of global impression of change in pain (p </= 0.02). The incidence of adverse events, including rash, was similar between LTG and placebo.


CONCLUSIONS
Lamotrigine was well-tolerated and effective for HIV-associated neuropathic pain in patients receiving neurotoxic antiretroviral therapy. Additional research is warranted to understand the differing response among patients receiving neurotoxic antiretroviral therapy compared with those not receiving neurotoxic antiretroviral therapy.
Mount Sinai School of Medicine (Dr. Simpson), New York, NY.
D M
DM
Simpson
J C
JC
McArthur
R
R
Olney
D
D
Clifford
Y
Y
So
D
D
Ross
B J
BJ
Baird
P
P
Barrett
A E
AE
Hammer
D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D015224:Dideoxynucleosides / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D000077213:Lamotrigine; D007866:Leg; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000139:chemically induced / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use*
D018712:Analgesics, Non-Narcotic; D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D014227:Triazines; D000077213:Lamotrigine