Evaluating Suzetrigine for Pain Control Following TKA

Официальное название

Evaluating a Non-Opioid Analgesic Strategy for Enhanced Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial of Suzetrigine

Обзор

The goal of this clinical trial is to learn if a non-opioid pain medicine called suzetrigine works to treat pain after total knee replacement surgery in adults. It will also learn about the safety of suzetrigine. The main questions it aims to answer are: Does suzetrigine lower the amount of opioid pain medicine participants use after surgery? Does suzetrigine have any effect on postoperative patient-reported outcomes, including pain scores, range of motion, length of stay, and KOOS/PROMIS surveys? Researchers will compare suzetrigine to a placebo to see if suzetrigine works to treat pain after total knee replacement surgery. Participants will: Take suzetrigine or a placebo by mouth for 14 days after surgery Receive standard pain care, including opioid pain medicine only if needed Report their pain levels using short daily surveys Attend routine follow-up visits after surgery

Подробное описание

Post-operative pain management following total knee arthroplasty (TKA) continues to present significant challenges. Despite multimodal Enhanced Recovery After Surgery (ERAS) protocols, over 60% of patients still require opioid medications two weeks after surgery. Given the ongoing opioid epidemic, opioid prescribing is a priority for quality improvement in orthopaedic surgery. High opioid exposure is associated with constipation, nausea, increased risk of falls, hindered rehabilitation, and persistent opioid use. Furthermore, opioid use within the early postoperative period following TKA is associated with a dose-dependent increased risk of periprosthetic joint infection and venous thromboembolic events. With over 700,000 TKAs performed each year in the United States, these complications represent not only individual patient risks but also broader public health concerns.

Multimodal pain regimens consisting of alternative analgesics such as acetaminophen, NSAIDs, and gabapentinoids may only provide partial relief for patients, leaving opioids as the default choice for managing breakthrough pain, despite their undesirable side effect profile and addictive potential.\[8\] This ongoing challenge underscores the urgent need to identify safer and more effective pain management strategies.

Suzetrigine (Brand name: Journavx), a selective inhibitor of NaV1.7/NaV1.8 channels, has emerged as a promising candidate. Phase 3 clinical trials have shown that suzetrigine provides pain relief comparable to opioids, effectively reducing pain scores, with fewer adverse effects. Data from phase 2 bunionectomy studies further support its opioid-sparing capabilities. Unlike opioids, suzetrigine does not cause sedation, respiratory depression, or dependency. Its favorable pharmacokinetic properties, including renal-sparing metabolism and convenient oral twice-daily dosing, make it well-suited for integration into ERAS protocols.

The purpose of this randomized controlled trial is to assess whether suzetrigine can serve as an effective, opioid-sparing analgesic after TKA. If the results are successful, this could lead to expanded FDA labeling, wider adoption in orthopaedic practices, and a significant decrease in opioid prescriptions on a large scale.

Вмешательства

• Препарат Suzetrigine
  Suzetrigine is an oral, non-opioid pain medication that works by blocking specific sodium channels involved in pain signaling. In this study, participants assigned to the suzetrigine group will receive a 100 milligram oral dose in the preoperative area, immediately prior to undergoing the procedure, followed by 50 milligrams taken by mouth twice daily for 14 days after surgery. Suzetrigine will be given in addition to standard postoperative pain care, including acetaminophen, nonsteroidal anti-i
• Препарат Placebo
  The placebo is an oral tablet designed to look like the suzetrigine tablet but contains no active drug. In this study, participants assigned to the placebo group will receive a tablet in the preoperative area immediately prior to the procedure, followed by placebo tablets taken by mouth twice daily for 14 days after surgery. The placebo will be given in addition to standard postoperative pain care, including acetaminophen, nonsteroidal anti-inflammatory drugs when appropriate, and opioid pain me

Первичные конечные точки

• Opioid Usage [Срок оценки: 2 weeks]

Вторичные конечные точки (6)

• Numeric Pain Rating Scale Scores [Срок оценки: 2 Weeks]
• Range of Motion [Срок оценки: 2 Weeks]
• Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Score [Срок оценки: 2 Weeks]
• Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Score [Срок оценки: 2 Weeks]
• Knee Injury and Osteoarthritis Outcome Score (KOOS) [Срок оценки: 2 Weeks]
• Incidence of Treatment-Emergent Side Effects [Срок оценки: 2 Weeks]

Критерии участия

Критерии включения

• Age 18 years or older
• Scheduled for elective, unilateral primary total knee arthroplasty
• Able to tolerate oral medications after surgery

Критерии исключения

• Revision or bilateral total knee arthroplasty
• American Society of Anesthesiologists (ASA) physical status classification greater than 3
• Severe renal impairment (estimated glomerular filtration rate less than 15 mL/min/1.73 m²)
• Severe hepatic impairment (Child-Pugh Class C)
• Chronic opioid use of 30 morphine milligram equivalents per day or greater for more than 3 months
• Pregnancy or breastfeeding
• Seizure disorder or known hypersensitivity to suzetrigine
• Use of medications contraindicated with CYP3A metabolism
• Active gastrointestinal ulcer or bleeding

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Четверное слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• Hu S, Lyu D, Gao J. Suzetrigine: The first Nav1.8 inhibitor approved for the treatment of moderate to severe acute pain. Drug Discov Ther. 2025 Mar 6;19(1):80-82. doi: 10.5582/ddt.2025.01010. Epub 2025 Feb 27. PMID 40010720
• Hang Kong AY, Tan HS, Habib AS. VX-548 in the treatment of acute pain. Pain Manag. 2024 Sep;14(9):477-486. doi: 10.1080/17581869.2024.2421749. Epub 2024 Nov 18. PMID 39552600
• Hannon CP, Fillingham YA, Nam D, Courtney PM, Curtin BM, Vigdorchik JM, Buvanendran A, Hamilton WG, Della Valle CJ; AAHKS Anesthesia & Analgesia Clinical Practice Guideline Workgroup. Opioids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic S PMID 32571594
• Shichman I, Roof M, Askew N, Nherera L, Rozell JC, Seyler TM, Schwarzkopf R. Projections and Epidemiology of Primary Hip and Knee Arthroplasty in Medicare Patients to 2040-2060. JB JS Open Access. 2023 Feb 28;8(1):e22.00112. doi: 10.2106/JBJS.OA.22.00112. eCollection 2023 Jan-Mar. PMID 36864906
• Chung BC, Bouz GJ, Mayfield CK, Nakata H, Christ AB, Oakes DA, Lieberman JR, Heckmann ND. Dose-Dependent Early Postoperative Opioid Use Is Associated with Periprosthetic Joint Infection and Other Complications in Primary TJA. J Bone Joint Surg Am. 2021 Aug 18;103(16):1531-1542. doi: 10.2106/JBJS.21.00045. PMID 34043598
• Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015 May;23(5):267-71. doi: 10.5435/JAAOS-D-14-00163. PMID 25911660
• Sabatino MJ, Kunkel ST, Ramkumar DB, Keeney BJ, Jevsevar DS. Excess Opioid Medication and Variation in Prescribing Patterns Following Common Orthopaedic Procedures. J Bone Joint Surg Am. 2018 Feb 7;100(3):180-188. doi: 10.2106/JBJS.17.00672. PMID 29406338
• Atwood K, Shackleford T, Lemons W, Eicher JL, Lindsey BA, Klein AE. Postdischarge Opioid Use after Total Hip and Total Knee Arthroplasty. Arthroplast Today. 2021 Jan 30;7:126-129. doi: 10.1016/j.artd.2020.12.021. eCollection 2021 Feb. PMID 33553537

Идентификаторы

NCT: NCT07357376 · AH-ORTHO-JOURNAVX-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗