Suzetrigine (VX-548) exhibits activity-dependent effects on human dorsal root ganglion neurons with differential pain etiology

ABSTRACT: Nonselective antagonists of voltage-gated sodium channels (VGSCs) provide effective local analgesia, but systemic administration is fraught with unwanted cardiovascular and central nervous system toxicity. The development of antagonists targeting VGSCs preferentially expressed in peripheral neurons, such as Na V 1.7, 1.8, and 1.9, could mitigate these risks. One such new small molecule that selectively inhibits Na V 1.8, is orally bioavailable, and has recent FDA approval for the treatment of acute pain is suzetrigine (VX-548, brand name JOURNAVX). Here we tested the effects of this agent on human dorsal root ganglion neurons obtained from either patients undergoing surgical thoracic vertebrectomy or from organ donors in parallel electrophysiology studies across 2 laboratories. Bath application of 10 nM suzetrigine abolished spontaneous discharges previously shown to be associated with on-going neuropathic pain within minutes. In contrast, suppression of discharges evoked by intracellular current injection was moderate. These results suggest that suzetrigine will likely show efficacy vs spontaneous pain but may have less robust effects on evoked or breakthrough pain.