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Neuropathic Pain Severity Predicts Response to Duloxetine

Patients with diabetic peripheral neuropathic pain (DPNP) who have more severe symptoms are more likely to respond to duloxetine. Previous trials have demonstrated the effectiveness of duloxetine in reducing pain in patients with DPNP at 60 mg once daily and twice daily, explain Dr. Dan Ziegler from Leibniz Institute at the Heinrich Heine University, Duesseldorf, Germany, and associates.

The team evaluated the impact of various baseline disease characteristics on the efficacy and safety of duloxetine in the management of DPNP by pooling results of three studies involving almost 1000 patients.

The magnitude of improvement associated with duloxetine treatment was greater for individuals with more severe pain at baseline, the investigators report.

In contrast, the efficacy of duloxetine did not differ significantly according to age, type of diabetes, duration of diabetes, duration of diabetic neuropathy, severity of neuropathy, baseline hemoglobin A1c level, and baseline insulin use, the results indicate.

The rate of discontinuation of duloxetine due to adverse events did not differ by age, sex, type of diabetes, and baseline insulin use, the researchers note. On the other hand, the incidence of constipation differed by age, fatigue and diarrhea differed by sex, and nausea differed by type of diabetes and baseline insulin dose.

"These data suggest that duloxetine is more effective in patients with higher baseline pain severity or that there is a larger drug-placebo difference in patients with greater pain," Dr. Ziegler and colleagues conclude.

Diabetes Care 2007;30:664-669.

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