An Exploratory Retrospective Comparison of Crisugabalin and Pregabalin Among 12-Week Treatment Completers With Postherpetic Neuralgia.

backgroundPregabalin (PGB) is commonly used for postherpetic neuralgia (PHN), but its clinical effectiveness may be limited by insufficient pain relief or adverse events (AEs). Crisugabalin (CGB) is a novel α2δ-1 ligand that has demonstrated efficacy in randomized placebo-controlled trials. However, comparative real-world evidence for CGB and PGB remains limited.

methodsThis single-center retrospective cohort study included patients with PHN who completed at least 12 weeks of CGB or PGB monotherapy between January and June 2025. In October 2025, a single structured telephone interview was conducted to retrospectively assess patients' recalled status at treatment initiation (T0) and at Weeks 1, 4, and 12. Outcomes included the Numerical Rating Scale (NRS), Pittsburgh Sleep Quality Index (PSQI), and the physical and mental component summary scores of the 36-Item Short Form Health Survey (SF-36). Linear mixed effects models (LMMs) were designated as the primary analyses and adjusted for age, sex, pain location, pre-enrollment pain duration, hypertension, and diabetes. Repeated measures analysis of variance and the LMM analysis based on inverse probability weighting of propensity scores were performed as sensitivity analysis. Safety outcomes were descriptively assessed among treatment completers.

resultsA total of 113 patients were included, including 56 in the CGB group and 57 in the PGB group. In the adjusted LMMs, significant treatment-by-time interactions were observed for NRS scores (p < 0.001), PSQI scores (p < 0.001), and SF-36 mental component summary scores (p = 0.003), the extent to which these three scores of the CGB group improved over time may be higher than that of the PGB group. The treatment-by-time interactions were not statistically significant for SF-36 physical component summary scores (p = 0.377). Sensitivity analyses using repeated measures analysis of variance produced concordant findings for NRS, PSQI, and SF-36 mental component scores but not for SF-36 physical component scores. At least one AE was reported by 11 of 56 patients in the CGB group and 18 of 57 patients in the PGB group, but there was no overall significant difference in AEs (p = 0.196).

conclusionsAmong patients who completed 12 weeks of treatment, the CGB group was associated with statistical differences to some extent in NRS, PSQI, and SF-36 mental component scores than PGB group, and these degree of improvement over time may be more pronounced. Due to the substantial bias in retrospective studies and the relatively small sample size, these findings should be interpreted as exploratory, merely have reference value, and require more confirmation in prospective controlled studies in the future.