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Comparative clinical performance of mirogabalin, pregabalin, and gabapentin in diabetic neuropathy

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Created On: 23/01/2026

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Key take away

Mirogabalin sets a new benchmark in diabetic neuropathy, combining potent pain relief, improved sleep, and excellent tolerability.

Background

As a long-lasting complication of diabetes, diabetic peripheral neuropathic pain (DPNP) interferes with daily life and well-being. First-line Ca2⁺ α2δ ligands—mirogabalin (MGB), pregabalin (PGB), and gabapentin (GBP)—offer pain relief and functional improvement, but comparative evidence is limited. This review examined trials to rank the effectiveness, safety, and overall patient benefits of these three therapies for managing DPNP.

Method

A thorough search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify randomized controlled trials (RCTs) evaluating the effectiveness and safety of MGB, PGB, and GBP in DPNP. Studies were selected if they reported outcomes on pain relief, sleep quality, or side effects, while non-randomized trials and reviews were excluded.

Key measures included changes in pain scores, sleep interference, proportion of patients achieving meaningful pain reduction, overall adverse events, and treatment discontinuation due to side effects. Outcomes were presented using standard statistical measures for both continuous and categorical data, ensuring clear and comparable results.

Result

A total of 34 RCTs, including 8,630 patients across 13 dosing regimens, were analyzed.

MGB 30 mg significantly reduced average daily pain scores compared to PGB 300 mg (mean difference −0.29) and MGB 15 mg (mean difference −0.32).
Pain response rates (≥30% and ≥50%) were higher with MGB 30 mg than GBP 1800 mg (odds ratio 2.33 and 2.87, respectively).
MGB 30 mg and GBP 3600 mg achieved superior patient global impression of change (PGIC) scores versus PGB 300 mg and MGB 15 mg.
Sleep interference improved more with MGB 30 mg compared to GBP 1800 mg and PGB 300 mg.
Adverse events were lowest with MGB 15 mg, PGB 300 mg, and placebo, with MGB 15 mg showing the lowest withdrawal rates due to side effects.

No significant inconsistency or publication bias was detected, confirming the reliability of the findings.

Conclusion

MGB, particularly at 30 mg, provided superior pain relief, better sleep improvement, and excellent tolerability for DPNP, outperforming PGB and GBP in multiple outcomes. These findings reinforce Ca²⁺ channel α2δ ligands as first-line therapy for diabetic neuropathic pain, offering critical guidance for clinicians in optimizing patient care.

Source:

Pain and Therapy

Link:

https://link.springer.com/article/10.1007/s40122-025-00789-5

Article:

Efficacy and Safety of Ca2+ Channel α2δ Ligands for the Treatment of Diabetic Peripheral Neuropathic Pain: A Systematic Review and Network Meta-analysis