Single- Versus Multiple Drug Pharmacotherapy in the Management of Diabetic Neuropathy

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Single- Versus Multiple Drug Pharmacotherapy in the Management of Diabetic Neuropathy

Painful diabetic neuropathy is a one of the common but painful complication of diabetes. Neuropathy significantly contributes to the development of foot ulcers which is responsible for large health and social services expenditure. Diabetic painful neuropathy (DPN) occurs in both type 1 and type 2 diabetes and it is most common in those with poorly managed diabetes. Although diabetic neuropathy can occur in patients who have had diabetes for a short time.  Moreover, it is most likely to affect those who have been diabetic for more than a decade, especially those aged 40 and above. Diabetics who smoke are at higher risk.

A recent study compared the characteristics of patients with DPN receiving mono-pharmacotherapy. From the Inovalon's Medical Outcomes Research for Effectiveness and Economics Registry (MORE2) database, a retrospective cohort study was developed. On the date of first DPN prescription, patients which were included were ≥18 years and they were prescribed tricyclic antidepressant, opioids, duloxetine, gabapentin, pregabalin or lidocaine.  Authors conducted a simple proportional hazards model comparing times to discontinuation, switch or add on. Multiple logistic regression was used for the identification of the predictors of combination pharmacotherapy.

In this trial, 7145 patients were on mono-pharmacotherapy and 421 patients on combination pharmacotherapy. Patients who received combination pharmacotherapy were 130% and were more likely to discontinue their medications than patients who received mono-pharmacotherapy. Female patients and those with >7 comorbidities were more likely to outset with the combination pharmacotherapy. Female patients and those with >7 comorbidities were more likely to be started with combination pharmacotherapy. Elderly patients were less likely to be started with combination pharmacotherapy. The total cost of care difference between mono- and combination pharmacotherapy was not statistically significant (p=0.66).

Therefore, the newly treated DPN patients should add on another medication sooner than 30 days when considering combination pharmacotherapy. All first-line medications have shown the similar efficacy; for this reason.

Source:

J Pain Palliat Care Pharmacother

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/27541383

Original title of article:

Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy.

 

Authors:

Kuo KL, Brixner D, Lipman AG, Goodman M, Hung M, Oderda GM.

 

J Pain Palliat Care Pharmacother
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