Duloxetine and gabapentin equally effective in diabetic neuropathy: Study
Jodhpur, India: Both duloxetine and gabapentin are effective for providing symptomatic relief in painful diabetic neuropathy (PDN) patients and had similar efficacy, finds a recent study in the Journal of Diabetes.
Medicines that are sometimes used to treat depression or epilepsy can be effective in some people with neuropathic pain. Two such medications are duloxetine and gabapentin. Sameer Khasbage, All India Institute of Medical Sciences, Jodhpur, India, and colleagues analysed the efficacy and safety of Duloxetine and Gabapentin in painful diabetic neuropathy.
The researchers conducted a randomized, open label, active control for 12 weeks. It included 86 participants who were randomized to receive Gabapentin 300 mg and Duloxetine 60 mg in the ratio 1:1.
The primary efficacy objective was comparison of mean change in Visual Analogue scale (VAS) (0‐100 points) scores between duloxetine and gabapentin. The symptom scores and adverse events were assessed as secondary outcomes.
Key findings of the study include:
- Statistically significant improvement was observed in VAS scores in both Duloxetine group and Gabapentin group at 12 weeks as compared to baseline.
- However, no significant difference in VAS scores between duloxetine and gabapentin.
- Similar improvement in diabetic neuropathy symptom (DNS), diabetic neuropathy examination (DNE) and Neuropathic disability score (NDS) was observed in either group over 12 weeks.
- There were no significant differences in DNS, DNE and NDS scores between the two treatment groups.
- The overall safety evaluation of both Duloxetine and Gabapentin were similar.
- The most common adverse events reported were gastrointestinal.
"Our results indicate that both drugs were effective for the symptomatic relief from PDN and had similar efficacy. Follow‐up of patients was only for 12 weeks and therefore the long‐term efficacy and safety of the study drugs could not be assessed," concluded the authors.
Duloxetine is approved by the US Food and Drug Administration for the management of diabetic peripheral neuropathic pain (DPNP). The proposed mechanism of action of duloxetine, an antidepressant, is reuptake inhibition of both serotonin and norepinephrine in the central nervous system, which increases the activity of these neurotransmitters and subsequently reduces the perception of pain by modulating the pain signals.
Gabapentin is an anticonvulsant medication used for the treatment of partial seizures, neuropathic pain, hot flashes, and restless legs syndrome. Gabapentin appears to work by altering electrical activity in the brain and influencing the activity of chemicals called neurotransmitters, which send messages between nerve cells. It has shown to provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy.
The study, "A Randomized Control trial of Duloxetine and Gabapentin in Painful Diabetic Neuropathy," is published in the Journal of Diabetes.