Diabetic neuropathy is a common, long-term complication that can decrease quality of life. While various neuropathic agents are useful for treating this pain, choosing one or the other can be challenging. This systematic review investigated the relative effectiveness of various medications used for the treatment of diabetic neuropathy.
METHODSDatabases were reviewed for randomized, controlled trials published between January of 2012 and April of 2014. The trials assessed the efficacy of medications for treating diabetic neuropathy, and compared the medication to placebo or to another medication.
RESULTSSixty-five, randomized, controlled trials, including 27 medications with 12, 632 patients analyzed. By drug class, SNRIs, topical capsaicin, TCAs, and anticonvulsants all resulted in larger and statistically significant reductions in pain, as compared with placebo. Head-to-head trials showed that SNRIs and TCAs reduced pain more than did anticonvulsants and topical capsaicin. Studies that evaluated long-term efficacy found that the aldose reductase inhibitors fidarestat, duloxetine and oxcarbazepine are all more effective than placebo. Indirect and direct comparisons among specific medications revealed greater pain control with carbamazepine, venlafaxine, duloxetine and amitriptyline as compared with placebo.
CONCLUSIONThis systematic review and meta-analysis of pharmacologic interventions for painful diabetic neuropathy found that carbamazepine, venlafaxine, duloxetine and amitriptyline are significantly better than placebo for controlling pain.