William J. Peppard, PharmD, explains how emerging suzetrigine findings after knee arthroplasty connect opioid stewardship with functional recovery and the pharmacist’s role in ensuring treatment access.
Reducing opioid prescribing after knee replacement is meaningful only if patients can still recover well. A retrospective evaluation presented at PAINWeek 2026 found that adding suzetrigine (Journavx; Vertex Pharmaceuticals) to multimodal care was associated with fewer opioid refills and a greater proportion of patients being opioid-free at 6 weeks. For study coauthor William J. Peppard, PharmD, pain stewardship coordinator at Froedtert & the Medical College of Wisconsin, the practical question is whether those gains translate into better care.1
“The patient experience is what matters,” Peppard emphasized in an interview with Pharmacy Times.
Suzetrigine is a nonopioid NaV1.8 inhibitor approved to treat moderate to severe acute pain (including postoperative pain) in adult patients.2 Its phase 3 randomized trials evaluated pain after abdominoplasty or bunionectomy, but the knee arthroplasty evaluation examines its use within a different surgical population and an established multimodal regimen.3
The single-center evaluation included 104 patients undergoing primary or revision knee arthroplasty, divided equally between a suzetrigine cohort and historical controls. Patients receiving suzetrigine were more likely to avoid an opioid refill at or before the 2-week visit (57.7% vs 34.6%; P = .018) and to be opioid-free at 6 weeks (88.5% vs 65.4%; P = .005). There were no observed statistically significant differences in pain scores or functional recovery. The opioid-naïve subgroup also had fewer refills, although its difference in opioid-free status at 6 weeks did not reach statistical significance (91.5% vs 76.7%; P = .054).1
Peppard emphasized that a historical comparison cannot establish causation. Investigators reviewed medical records and queried providers about changes in practice. A concurrent health system initiative reduced postoperative gabapentin use, which he believed could have made suzetrigine’s benefit harder to demonstrate.
“We don't have the data to show that this is a cause and effect. So right now, it's just an association,” he said. The findings also concern prescribing rather than exact consumption. “We recognize that what is prescribed is a surrogate, and at best an estimate of what patients are actually using at home.”
That distinction matters. A systematic review of 6 studies involving 810 surgical patients found that approximately 42% to 71% of opioid tablets obtained went unused.4 Medication diaries or pill counts would help future evaluations determine how prescribing changes translate into actual exposure.
Peppard cautioned against defining success solely through morphine milligram equivalents. Functional recovery and quality of life remain central, even when an intervention does not improve those measures beyond usual care.
“If we can get away with achieving the same outcomes with using less risky treatment, that's value added,” he said. The evaluation did not establish a reduction in opioid-related adverse events. Peppard instead described avoiding those events as a potential benefit of reducing opioid use or shortening its duration.
Opioid-tolerant patients were underrepresented, limiting conclusions about their response. Peppard identified patients taking other central nervous system depressants, including benzodiazepines, and those with underlying pulmonary disease as populations in whom opioid-sparing strategies warrant particular consideration. These were clinical considerations, rather than demonstrated subgroup benefits.
Pharmacists must still assess suzetrigine’s own prescribing requirements. Strong CYP3A inhibitors are contraindicated, moderate inhibitors require dose modification, and strong or moderate CYP3A inducers should be avoided. It is important to note that use for acute pain has not been studied beyond 14 days.2
Cost can interrupt care before treatment begins. Peppard said that, in an internal review of claims processed through his institution’s retail pharmacies, approximately half of patients obtained insurance coverage with an out-of-pocket cost around $30. The remainder relied on manufacturer assistance. Those local findings should not be interpreted as national coverage estimates.
“If they can't or won't pay the cost of the medication, they're not going to take it,” he explained.
Peppard urged teams to address coverage and prior authorization before surgery. A patient asked to collect medication on the way home may encounter delays that undermine the likelihood of starting treatment. For pharmacists, planning ahead means confirming that patients can obtain the prescribed regimen and coordinating alternatives when access falls through.
“It doesn't stop when the medication is prescribed,” Peppard said. “There's a lot more to it.”
