In Painful Diabetic Peripheral Neuropathy, Best Treatment is Unclear

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Researchers were unable to determine the most effective treatment for painful diabetic peripheral neuropathy in a network meta-analysis, according to a study published in the Annals of Internal Medicine.

Lead researcher Marcio L. Griebeler, MD, of the Division of Diabetes, Endocrinology, Metabolism, and Nutrition at the Mayo Clinic, and colleagues found that there were not enough head-to-head, unbiased, long-term trials to allow for sufficient comparison of different treatments.

The study included 65 randomized, controlled trials that involved 12,632 patients and 27 pharmacologic interventions. Approximately half of the studies had high or unclear risk of bias.

The researchers found greater pain reduction associated with serotonin-norepinephrine reuptake inhibitors (SNRIs) than anticonvulsants, and with tricyclic antidepressants (TCAs) than topical capsaicin. A meta-analysis showed that SNRIs, topical capsaicin, TCAs, and anticonvulsants performed better than placebo for short-term pain control.

The study was limited since most evidence came from indirect comparisons of trials with ≤ 3 months of follow-up and unclear or high risk of bias.

In a related commentary, Brian C. Callaghan, MD, MS, and Eva L. Feldman, MD, PhD, of the University of Michigan noted that only pregabalin (anticonvulsant) and duloxetine (SNRI) are currently approved by the FDA for the treatment of painful diabetic neuropathy, which may discourage clinicians from trying other classes of therapy. They noted that because the most effective treatment is currently unclear, patients and clinicians should consider costs, potential adverse effects, and comorbidities.

The researchers noted that more long-term, head-to-head studies should be undertaken to better determine the most effective treatment for painful diabetic peripheral neuropathy.

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In Painful Diabetic Peripheral Neuropathy, Best Treatment is Unclear

Researchers from the Mayo Clinic evaluated the comparative effectiveness of oral and topical analgesics for diabetic neuropathy in a meta-analysis of parallel or crossover randomized, controlled trials that evaluated pharmacologic treatments for adults with painful diabetic peripheral neuropathy.

65 randomized, controlled trials involving 12 632 patients evaluated 27 pharmacologic interventions. Approximately one half of these studies had high or unclear risk of bias. Nine head-to-head trials showed greater pain reduction associated with serotonin–norepinephrine reuptake inhibitors (SNRIs) than anticonvulsants (standardized mean difference [SMD], −0.34 [95% credible interval {CrI}, −0.63 to −0.05]) and with tricyclic antidepressants (TCAs) than topical capsaicin 0.075%.

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