Title:Progress in Analgesic Development: How to Assess its Real Merits?
Volume: 17
Issue: 2
Author(s): Igor Kissin*
Affiliation:
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical
School, Boston. MA, USA
Keywords:
Acute pain, chronic pain, migraine, molecular targets, pain syndromes, scientometrics.
Abstract:
Background: Assessing analgesic drugs developed over preceding 50 years demonstrated
that very intensive efforts directed at diverse molecular pain targets produced thousands of
PubMed articles and the introduction of more than 50 new analgesics. Nevertheless, these analgesics
did not have a sufficiently broad spectrum of action and level of effectiveness to demonstrably
affect the use of opioids or nonsteroidal anti-inflammatory drugs for the treatment of pain. Analgesics
in current are only modestly effective in chronic pain (at least with respect to neuropathic
pain), and the widespread application of mu-opioid receptor agonists for this purpose culminated in
the global “opioid crisis”. The introduction of every new drug is regarded as an important success,
at least initially. Assessing the merit of a new analgesic is extremely complicated.
Objective: The aim of this article is to describe an approach that combines very different categories
of drug evaluation – multifactorial approach for the assessment of new analgesics. It is based on
conclusiveness of clinical trials, novelty of a drug’s molecular target, a drug’s commercial appeal,
and the interest in a drug reflected by scientometric indices.
Results: This approach was applied to analgesics developed in 1982-2016. It shows that although
several new agents have completely novel mechanisms of action, all newly approved drugs, and
drug candidates, demonstrated the same persistent problems: relatively low therapeutic advantage
over previous treatment and narrow spectrum of use in different types of pain, compared to opioids
or NSAIDs.
Conclusion: The use of the suggested multifactorial approach to drug assessment may provide a
better view of the whole spectrum of analgesics advantages and disadvantages.
