P-084 - Decreased Opioid Utilization with Lidocaine Topical System 1.8% Compared to Lidocaine 5% Patch: A Retrospective Claims Analysis

Abstract Title: Decreased Opioid Utilization with Lidocaine Topical System 1.8% Compared to Lidocaine 5% Patch: A Retrospective Claims Analysis


Background: CDC Clinical Practice Guidelines for Prescribing Opioids for Pain recommends maximizing non-opioid pharmacologic therapies and reducing the use of opioids for the treatment of chronic pain¹. Topical lidocaine systems are an appealing non-opioid option because of their additive efficacy with limited adverse events. Published studies have demonstrated that treatment with lidocaine topical systems can reduce concomitant opioid utilization². ZTlido (lidocaine topical system 1.8%, “LTS”) and Lidoderm (lidocaine 5% patch, “LP”) are bioequivalent prescription lidocaine topical systems approved for the relief of pain associated with post-herpetic neuralgia. In clinical studies, LP demonstrated inferior adhesion performance to LTS, which may result in inadequate pain relief and potentially impede the ability of patients to reduce opioid utilization³.

Purpose/Objectives: Evaluate the impact of LTS and LP on the utilization of opioids in patients with neuropathic pain.

Methods: Using retrospective claims data from Optum’s de-identified Normative Health Informatics database (5/2018 to 9/2023), we evaluated the impact of LTS and LP on the utilization of opioids in patients with neuropathic pain (post-herpetic neuralgia, diabetic peripheral neuropathy or lower back pain).

Results: The final analysis included 6,014 patients taking opioids and either LTS or LP index treatment. 51.9% of LTS patients experienced either a decrease or discontinuation of opioid use in the post-prescription period compared to 45.5% of LP patients (Chi-square test, p=0.021). LTS patients had a non-significant change in pre- versus post-prescription median Morphine Milligram Equivalents (MME) (3.1% increase, Wilcoxon signed rank test, p=0.146); while LP patients experienced a significant increase in pre-versus post-prescription median MME (42.9% increase, Wilcoxon signed rank test, p< 0.001).

Conclusions/Implications for future research and/or clinical care: Based on these data, LTS usage may be associated with reduced opioid utilization compared with LP. Further analysis of the data is needed to understand the patient subpopulations that are most impacted.

References: <Dowell D, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR 2022;71(3): 1-95

< 2. Clere F, et al. 5% Lidocaine Medicated Plaster in Elderly Patients with Post-Herpetic Neuralgia. Drugs Aging 2011; doi: 10.2165/11595600-000000000-00000

3.Gudin J, et al. Open-label Adhesion Performance Studies of a New Lidocaine Topical System 1.8% versus Lidocaine Patches 5% and Lidocaine Medicated Plaster 5% in Healthy Subjects..