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Topical TV-45070 8% ointment in herpes zoster pain not effective

Teva Pharmaceutical Industries Ltd. at the end of June 2017 disclosed the results of a Phase II study analysing topical TV-45070 4% and 8% oil in patients with post-herpetic neuralgia (PHN). The ointment treatment (twice a day) did not reduce the primary endpoint, pain measured via the NRS, at week four compared to placebo. However, there were no side effects.

The study was carried out at 48 centers in the US and involved 300 patients randomized to 100 patients receiving 4% TV-45070, 100 patients receiving 8% TV-45070 and 100 patients receiving placebo.

TV-45070: a sodium channel Nav 1.7 inhibitor

TV-45070 is a small-molecule inhibitor of the sodium channel Nav1.7, expressed in the pain-sensing peripheral nervous system.

This is unfortunate for TEVA, but on hindsight PHN might also not be the best indication due to the specific pathogenesis and the mechanism of action of topical sodium channel blockers.

Phenytoin cream for neuropathic pain

In the same class as the TEVA compound we find phenytoin.
Phenytoin however is a broad acting sodium channel blocker with additional mechanisms of action, and formulated in cream might have certain advantages, and might be more fit to influence the specific targets in the skin.

The datapool of patients treated with phenytoin cream is growing and Topical Innovations reached already 50 patients, all described in great detail. At the Neupsig in Gothenburg (June 2017) there was also much interest in these recent findings.

Literature on topical phenytoin