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Approved Drugs Show Similar Efficacy for Diabetic Peripheral Neuropathic Pain

Duloxetine, pregabalin, and gabapentin offer similar efficacy for patients with diabetic peripheral neuropathic pain, according to a new report. 

Few direct comparisons have been conducted between drugs approved or recommended for the treatment of diabetic peripheral neuropathic pain, the authors explain.

Dr. Jeremy Chancellor from i3 Innovus, Uxbridge, UK, and colleagues used statistically pooled data from randomized, placebo-controlled trials to compare the efficacy and tolerability of duloxetine, pregabalin, gabapentin, and amitriptyline for diabetic peripheral neuropathic pain.

Duloxetine, pregabalin, and gabapentin were all superior to placebo for all efficacy parameters, the authors report.
In indirect comparisons (using placebo as the common comparator), pregabalin was slightly superior to duloxetine in the patient global impression outcomes, but duloxetine caused significantly less dizziness than did pregabalin.

There were no significant differences in indirect comparisons of duloxetine and gabapentin in efficacy or tolerability, the researchers note.

“Based on the pooling of common outcomes measured in randomized, controlled trials, we conclude that duloxetine is comparably effective and tolerable in the treatment of diabetic peripheral neuropathic pain to two anticonvulsants, gabapentin and pregabalin, which are pharmacologically unrelated to duloxetine,” the investigators say.

“In neuropathic pain,” they add, “the empirical approach to treatment and the common use of off-label treatments attest to the clinical need for a wide range of drug choices. This study suggests that duloxetine may offer a valuable, additional option for this disabling condition.”

Eli Lilly and Co., manufacturer of duloxetine, sponsored the research.

BMC Neurol 2009;9:6. Feb 10, 2008