Comparison of duloxetine vs. placebo as treatment for patients with diabetic peripheral neuropathic pain

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Comparison of duloxetine vs. placebo as treatment for patients with diabetic peripheral neuropathic pain
Key Take-Away: 

Anti-depressants have analgesic action as well especially in chronic painful conditions. This group of investigators has successfully treated diabetic neuropathy pain with duloxetine and has tried to address an area of huge unmet need.

Duloxetine has been approved in the United States, European Union and some Asian countries for the treatment of diabetic peripheral neuropathic pain (DPNP). We assessed the efficacy and safety of duloxetine (60 mg once daily) as compared with placebo in Chinese patients suffering from DPNP.

ABSTRACT: 
Background: 

Duloxetine has been approved in the United States, European Union and some Asian countries for the treatment of diabetic peripheral neuropathic pain (DPNP).

We assessed the efficacy and safety of duloxetine (60 mg once daily) as compared with placebo in Chinese patients suffering from DPNP.

Methods: 

This was a phase 3, multicenter, randomized, double-blind, parallel, placebo-controlled, 12-week trial of the treatment of DPNP with duloxetine.

Subjects were male and female outpatient’s ≥ 18 years of age with DPNP, as assessed by the Michigan Neuropathy Screening Instrument, and had a rating of ≥ 4 on the Brief Pain Inventory- Modified Short Form-Severity weekly average pain item. The primary efficacy measure was the reduction in pain severity from baseline to 12 weeks, as measured by the weekly mean of 24-h average pain ratings recorded in the patient’s diary. Mean changes from baseline in efficacy measures were analyzed by a restricted maximum likelihood-based, mixed-effects model repeated measures approach and by analysis of covariance. 

Results: 

Of the 405 patients randomized, 203 patients were assigned to duloxetine 60 mg once daily and 202 patients were assigned to placebo.

Duloxetine treated patients showed significantly greater pain relief on 24-h average pain ratings compared with placebo treated patients each week of the 12-week study period [week 12: least squares (LS) mean change duloxetine: -2.40, placebo: -1.97; LS mean change difference (95% confidence interval) = -0.43 (-0.82, -0.04), p = 0.030]. Compared with placebo, patients treated with duloxetine experienced higher rates of nausea (p = 0.010), somnolence (p < 0.001) and asthenia (p = 0.002).

Conclusion: 

Duloxetine treated patients showed significantly greater pain relief compared with placebo-treated patients over the 12-week study period. Duloxetine was shown in Chinese patients to have a safety profile similar to that found in previous duloxetine trials.

Int J Clin Pract. 2015 May 4; 1-10