Triple combo of alpha-lipoic acid, epalrestat, and mecobalamin better for treating diabetic peripheral neuropathy than monotherapy : study

Alpha-lipoic acid, epalrestat, and mecobalamin are widely used as monotherapies for diabetic peripheral neuropathy. However, whether a triple-combination therapy with these three drugs is superior to monotherapy or dual therapy remains debatable. Nine randomized controlled trials were identified through a search on electronic databases such as PubMed, Web of Science, and Cochrane Library. The trial participants (N = 1153) were divided into the experimental group which received the triple-combination therapy and the control group who received conventional or dual therapy with the aforementioned drugs. Results: Therapeutic outcomes were better in the experimental group than in the control group (odds ratio: 3.74; 95 % confidence interval: 2.57–5.45; I2 = 0 %; p < 0.00001).

No statistical difference was noted in adverse effects. Compared with the control group, the experimental group exhibited significant improvements in median motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and vibration perception thresholds (VPT) in the left and right lower limbs. In the control group, a subgroup analysis by treatment strategy revealed similar improvements in total efficacy, MNCV, and SNCV. For diabetic peripheral neuropathy, triple-combination therapy may be more effective than monotherapy or dual therapy.

Reference:

Gui-Lin Ran, Yan-Ping Li, Li-Chin Lu, Shao-Huan Lan. Disease-modifying therapies for diabetic peripheral neuropathy: A systematic review and meta-analysis of randomized controlled trials. Journal of Diabetes and its Complications, Volume 38, Issue 2, 2024, 108691, ISSN 1056-8727. https://doi.org/10.1016/j.jdiacomp.2024.108691. (https://www.sciencedirect.com/science/article/pii/S1056872724000175)