Comparative Efficacy of Duloxetine, Gabapentin for Diabetic Peripheral Neuropathic Pain

A systematic review and meta-analysis found that duloxetine was not more efficacious than gabapentin for the treatment of diabetic peripheral neuralgia but was associated with a more favorable safety profile. These findings were published in Contrast Media & Molecular Imaging.

Investigators from 3 universities publication databases through October 2021 for studies of treatments for diabetic peripheral neuropathic pain (DPNP). A total of 7 randomized controlled trials comprising 624 patients were included.

For this study, the experimental group was treated with duloxetine (n=314) and the control group with gabapentin (n=310). The primary outcome was changes to the visual analogue scale (VAS) pain score.

No significant effect to pain scores were observed for the experimental compared with control treatments (standardized mean difference [SMD], -0.26; 95% CI, -0.53 to 0.002; P =.07; I², 66%). To correct for heterogeneity, a 1-by-1 approach did not identify a significant effect on VAS pain scores (SMD, -0.14; 95% CI, -0.31 to 0.03; P =.12; I², 0%).

Similarly, no differences were observed for response rate (relative risk [RR], 1.05; 95% CI, 0.92-1.20; P =.47; I², 0%) or clinical global impression of change scores (SMD, 0.07; 95% CI, -0.20 to 0.35; P =.6; I², 0%).

Duloxetine was observed to have a lower sleep interference rate compared with gabapentin (SMD, -0.35; 95% CI, -0.63 to -0.08; P =.01; I², 0%) and was associated with decreased risk for adverse reactions (RR, 0.59; 95% CI, 0.45-0.79; P =.0003; I², 0%).

This study was limited by the paucity of data and by the small sample sizes in the underlying studies. In addition, all studies were conducted in Asian countries, so these finding may not be generalizable among more diverse populations.

This study found that both duloxetine and gabapentin had similar efficacy for the treatment of DPNP, however, duloxetine was associated with a more favorable safety profile, which may make it the more advantageous treatment strategy.

Reference

Jiang L, Xiong Y, Cui J. Comparison of the efficacy and safety of duloxetine and gabapentin in diabetic peripheral neuropathic pain: a meta-analysis. Contrast Media Mol Imaging. 2022;2022:4084420. doi:10.1155/2022/4084420