Vertex Pharmaceuticals presented Phase 3 data at the American Society of Anesthesiologists (ASA) annual meeting highlighting the potential of suzetrigine, an investigational oral, highly selective NaV1.8 pain signal inhibitor, for treating acute pain. The data, from randomized controlled trials, suggest suzetrigine could offer a non-opioid alternative for managing moderate-to-severe acute pain. The FDA has granted suzetrigine Fast Track and Breakthrough Therapy designations, with a decision expected by January 30, 2025.
Phase 3 Efficacy and Safety Results
Two randomized, double-blind, placebo-controlled trials evaluated suzetrigine's efficacy in patients experiencing moderate to severe pain following bunionectomy and abdominoplasty. Both trials met their primary endpoints, demonstrating a statistically significant improvement in the time-weighted sum of pain intensity difference from 0 to 48 hours compared to placebo. Patients also reported a clinically meaningful reduction in pain from baseline at 48 hours, as measured by the Numeric Pain Rating Scale (NPRS).
In the abdominoplasty trial, the least squares (LS) mean difference in SPID48 between suzetrigine and placebo was 48.4% (95% CI: 33.6, 63.1; P < .001). In the bunionectomy trial, the LS mean difference was 29.3% (95% CI: 14.0, 44.6; P = .0002).
However, neither trial met the key secondary endpoint of superiority over hydrocodone/acetaminophen for pain relief. Suzetrigine did demonstrate a faster onset of meaningful pain relief compared to placebo. The median time to achieve a 2-point or greater reduction in NPRS from baseline was significantly shorter with suzetrigine (119 minutes in the abdominoplasty trial and 240 minutes in the bunionectomy trial) compared to placebo (480 minutes in both trials; P < .001 and P = .0016, respectively).
A separate single-arm safety and effectiveness study assessed suzetrigine treatment for up to two weeks across various surgical and non-surgical pain conditions. The study reported a favorable safety profile, with no serious adverse events related to suzetrigine. Furthermore, 83.2% of study participants rated suzetrigine as good, very good, or excellent at treating pain, according to a Patient Global Assessment.
Mechanism of Action and Potential Benefits
Suzetrigine is a highly selective inhibitor of the NaV1.8 voltage-gated sodium channel, which is primarily expressed in peripheral nociceptors. By selectively inhibiting NaV1.8, suzetrigine aims to block pain signals without the addictive potential associated with opioids. This mechanism offers a novel approach to pain management, potentially filling a critical gap between opioids and other currently available therapies with limited efficacy or poor tolerability.
Expert Commentary
Todd Bertoch, MD, CEO of CenExel JBR Clinical Research and lead presenter of the Phase 3 data, expressed optimism about suzetrigine's potential: "Suzetrigine offers the potential to fill the critically important treatment gap between opioids and other currently available therapies that have either limited efficacy and/or poor tolerability."
Scott Weiner, MD, MHP, associate professor of emergency medicine at Brigham and Women’s Hospital and acute pain steering committee chair at Vertex, highlighted the need for new options: "Prescribers and patients deserve new options."
