Authors: Mantas Dmukauskas , PhD ⊕,Truveta, Inc, Bellevue, WA, Puja Rao, MPH ⊕, Truveta, Inc, Bellevue, WA, Amy Sullivan, MS ⊕, Truveta, Inc, Bellevue, WA, Joud Rafael, MPH ⊕, Truveta, Inc, Bellevue, WA, Jared Kearn ⊕, Truveta, Inc, Bellevue, WA, Nadia Tabatabaeepour, MPH ⊕Truveta, Inc, Bellevue, WA, Vidya Venkataraman, PhD ⊕Truveta, Inc, Bellevue, WA, Sarah Eng, MPH ⊕, Truveta, Inc, Bellevue, WA, Amy Wu ⊕, Truveta, Inc, Bellevue, WA, Esther Kim, PhD ⊕Truveta, Inc, Bellevue, WA,
- Fewer than one-third of patients with trigeminal neuralgia (TN) received guideline-recommended first-line therapy within one year of diagnosis.
- Second-line therapies and opioids were more commonly used than first-line therapies, suggesting opportunities to improve alignment between real-world TN management and clinical guidelines.
This report summarizes our poster presented at ISPE 2026, titled Real-world evidence of trigeminal neuralgia treatment patterns.
Trigeminal neuralgia is a chronic neuropathic pain disorder characterized by recurrent, stabbing facial pain that can substantially reduce quality of life (1). Clinical guidelines recommend carbamazepine or oxcarbazepine as first-line treatment, while other medications, including gabapentin, baclofen, lamotrigine, and related therapies, may be used when first-line treatments are not effective or tolerated (2, 3). However, evidence describing how TN is treated in routine clinical practice remains limited (4).
Using a subset of Truveta Data, we examined treatment patterns following TN diagnosis, including use of first-line therapies, second-line therapies, and opioids.
Methods
We identified patients with at least one recorded TN diagnosis between 2017 and 2024 using SNOMED CT, ICD-10-CM, and ICD-9-CM diagnosis codes. The first observed TN diagnosis was considered the index date.
Medication use was assessed during the 365 days following diagnosis. First-line therapy included carbamazepine and oxcarbazepine. Second-line therapy included lamotrigine, baclofen, gabapentin, and pregabalin. We also evaluated opioid use. Treatments were identified using NDC, RxNorm, and CPT codes, and descriptive statistics were used to characterize treatment patterns.
Results
Fewer than one-third of patients received first-line therapy
We identified 143,696 patients with TN. The median age at diagnosis was 62.5 years, and 72.7% of patients were female. TN diagnoses were most common among patients aged 45–64 years, who represented 34.9% of the cohort, followed by patients aged 65–74 years (24.1%) and 75 years or older (22.9%), as shown in Figure 1 of the poster.
Within one year of diagnosis, 29.2% of patients received guideline-recommended first-line therapy. In comparison, 42.4% received a second-line therapy and 38.7% received an opioid. These findings show that second-line therapy and opioid use were more common than use of carbamazepine or oxcarbazepine during the first year following diagnosis.
First-line therapy increased modestly over time
The proportion of patients receiving first-line therapy within 90 days of diagnosis varied from 22.8% to 28.3% between 2017 and 2024. Although first-line treatment increased overall during this period, roughly two-thirds of patients still did not receive guideline-recommended first-line therapy.
Discussion
In this large real-world cohort of patients with TN, fewer than one-third received carbamazepine or oxcarbazepine within the first year after diagnosis, despite clinical guidelines recommending these medications as first-line treatment (2, 3). At the same time, second-line therapies and opioids were commonly used. These findings suggest a potential gap between guideline recommendations and treatment patterns observed in routine clinical practice.
Future research should examine treatment sequencing, switching, persistence, and the factors associated with opioid use after TN diagnosis. Understanding these treatment pathways may help identify opportunities to improve evidence-based management for patients living with TN.
Data are constantly changing and updating. These findings are consistent with data analyzed for the ISPE 2026 study.
Citations
- L. N. Melek, M. Devine, T. Renton, The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg. 47, 869–878 (2018).
- L. Bendtsen, J. M. Zakrzewska, J. Abbott, et al., European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 26, 831–849 (2019).
- G. Gronseth, G. Cruccu, J. Alksne, et al., Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review). Neurology 71, 1183–1190 (2008).
- J. M. Zakrzewska, J. Wu, M. Mon-Williams, N. Phillips, S. H. Pavitt, Characterizing treatment utilization patterns for trigeminal neuralgia in the United States. Clin J Pain 34, 691–699 (2018).
