CLINICAL QUESTION

Is suzetrigine (Journavx) safe and effective for postoperative pain?

BOTTOM LINE

Suzetrigine is a novel analgesic given every 12 hours that provides modest postoperative pain reduction similar to hydrocodone-acetaminophen, 5 mg/325 mg given every 6 hours. The dose and interval for the comparator are at the low end of the range. It would have been helpful for the study to include a nonopioid comparator such as ibuprofen, 600 mg, but it did not. Suzetrigine costs $15.50 per tablet ($227 for a 1-week course). (Level of Evidence = 1b)

SYNOPSIS

Suzetrigine is a novel analgesic that inhibits the voltage-gated sodium channel 1.8, which transmits action potentials in peripheral nerves. Because it works peripherally, in theory, it should not be addictive. In the two industry-sponsored phase 3 trials, researchers identified adults 18 to 80 years of age who had undergone abdominoplasty with general anesthesia (n = 1,118) or unilateral bunionectomy with a field block or regional anesthesia (n = 1,073). Patients with moderate or severe postoperative pain (defined as at least a 4 on a 10-point visual analog scale) were randomized in a 2:2:1 ratio to receive a loading dose of suzetrigine, 100 mg, then 50 mg every 12 hours; hydrocodone-acetaminophen, 5 mg/325 mg every 6 hours; or placebo.