Cancer Patients with Neuropathic Pain: Pharmacist-Led Recommendation and Management and Mirogabalin Outcomes in a Single-Center Retrospective Observational Cohort.

Abstract

This single-center retrospective cohort study assessed whether pharmacist-led recommendation and management was associated with effectiveness and safety outcomes of mirogabalin for cancer-related neuropathic pain. Among 143 patients prescribed mirogabalin, 85 adults with malignancy were included. Patients were classified into a pharmacist-led recommendation and management group (n = 18), in which a board-certified oncology pharmacist recommended mirogabalin and supported subsequent prescribing, or a usual-care-without-pharmacist-recommendation group (n = 67), in which mirogabalin was prescribed without a pharmacist-led recommendation. The primary endpoint was recorded subjective effectiveness, defined as documented pain relief or symptom improvement in the electronic health record; the per-protocol analysis excluded non-evaluable records, leaving denominators of 13 and 52, respectively. Recorded subjective effectiveness was 13/13 (100.0%) in the pharmacist-led recommendation group versus 36/52 (69.2%) in the usual-care-without-pharmacist-recommendation group (p = 0.027). In an ITT-like conservative sensitivity analysis, the direction of association was consistent but not statistically significant (13/18 [72.2%] vs 36/67 [53.7%]; p = 0.188). AE-related discontinuation occurred in 1/18 (5.6%) patients in the pharmacist-led recommendation group versus 8/67 (11.9%) patients in the usual-care-without-pharmacist-recommendation group (p = 0.677). Pharmacist-led recommendation and management was associated with higher recorded subjective effectiveness of mirogabalin in the per-protocol analysis. These findings are hypothesis-generating and support prospective evaluation of pharmacist-supported mirogabalin initiation in cancer-related neuropathic pain.