Research Article | Volume: 11, Supplement 1, March, 2021

Comparison of safety and efficacy of pregabalin, duloxetine and their combination with epalrestat in diabetic neuropathy: A prospective, double-blind, randomized, controlled Trial

Ravinder Singh Harbir Kaur Rao Thakur Gurjeet Singh   

Open Access   

Published:  Feb 09, 2021

DOI: 10.7324/JAPS.2021.11s108
Abstract

Neuropathic pain is a common disorder characterized by negative and positive subjective signs and symptoms ranging from numbness to crippling pain. Type 2 diabetes mellitus (T2DM) is the primary cause of neuropathy and neuropathic pain. Diabetic neuropathic pain (DPN) is one of the most common diabetes mellitus complications. The study was aimed to analyze the efficacy and safety of Pregabalin, Duloxetine, and their combination with Epalrestat in T2DM neuropathic patients. The study was conducted on 200 subjects. The patients were divided into 4 groups each comprising of 50 patients. Group I(P) was subjected to Pregabalin (150 mg O.D), Group II (D) to Duloxetine (60 mg O.D), Group III (P + E) to Pregabalin + Epalrestat (150 mg + 100 mg (O.D), and Group IV (D + E) to Duloxetine +Epalrestat (60 mg + 100 mg (O.D) and) for a period of 6 months. Various clinical parameters like vibration perception threshold, gycated haemoglobin level, visual analog scale, DPNdiabetic diagnostic questionnaire, advance glycated end products, thiobarbituric acid reactive substances, C-reactive proteins, SF12 score, and cost-effectiveness were assessed at baseline and 3 and 6 months. Results demonstrated that Pregabalin and Epalrestat therapy has a better effect on neuropathic pain reduction than Duloxetine and Epalrestat with strict glycemic control and favorably contributes to the health effective benefits by inhibiting disease progression and fulfills the alternate goals of management of DPN. It has been suggested that Pregabalin and Epalrestat therapy is more efficacious and armamentarium for patients with DPN. It has been suggested that Group III therapy is more efficacious, cost-effective, and armamentarium for patients with DPN.


Keyword:     Diabetes mellitus neuropathic pain pregabalin duloxetine epalrestat.


Citation:

Singh R, Rao HK, Singh TG. Comparison of safety and efficacy of pregabalin, duloxetine and their combination with epalrestat in diabetic neuropathy: A prospective, doubleblind, randomized, controlled trial. J Appl Pharm Sci, 2021;11 (Supp 1):071–079.

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Reference

Alles SR, Smith PA. The anti-allodynic gabapentinoids: myths, paradoxes, and acute effects. The Neuroscientist. , 2017; 23(1):40--55.https://doi.org/10.1177/1073858416628793

Argoff CE, Cole BE, Fishbain DA, Irving GA. Diabetic peripheral neuropathic pain: clinical and quality-of-life issues. Mayo Clin Proc, 2006; 81(4):S3-S11.https://doi.org/10.1016/S0025-6196(11)61474-2

Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J, 2006; 82(964):95-100. https://doi.org/10.1136/pgmj.2005.036137

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, JafariSchluep H. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain, 2005; 114(1-2):29-36.
https://doi.org/10.1016/j.pain.2004.12.010

Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol, 2012; 11(6):521-34.https://doi.org/10.1016/S1474-4422(12)70065-0

Charles EA, Cole BE, Fishbain DA, Irving GA. Diabetic peripheral neuropathic pain: clinical and quality-of-life issues. Mayo Clin Proc, 2006; 81(4):S3-11.https://doi.org/10.1016/S0025-6196(11)61474-2

Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C. Neuropathic pain. Nature rReviews Disease pPrimers. , 2017; 3(1):1--9.
https://doi.org/10.1038/nrdp.2017.2

Craige SM, Reif MM, Kant S. Mixed-lineage protein kinases (MLKs) in inflammation, metabolism, and other disease states. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease., 2016; 1862(9):1581--6.
https://doi.org/10.1016/j.bbadis.2016.05.022

Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med, 2004; 21(9):976-82.https://doi.org/10.1111/j.1464-5491.2004.01271.x

Detsky AS, Naglie IG. A clinician's guide to cost-effectiveness analysis. Ann Intern Med, 1990; 13(2):147-54.
https://doi.org/10.7326/0003-4819-113-2-147

Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Clin Pharmacol Ther, 2008; 120(1):1-34.https://doi.org/10.1016/j.pharmthera.2008.05.005

Farmer AJ, Perera R, Ward A, Heneghan C, Oke J, Barnett AH, Davidson MB, Guerci B, Coates V, Schwedes U, O'Malley S. Metaanalysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ, 2012; 27;344:486.https://doi.org/10.1136/bmj.e486

Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol, 1990; 17:1022-4.

Freynhagen R, Serpell M, Emir B, Whalen E, Parsons B, Clair A, Latymer M. A comprehensive drug safety evaluation of pregabalin in peripheral neuropathic pain. Pain Practice., 2015; 15(1):47--57.
https://doi.org/10.1111/papr.12146

Garrow AP, Boulton AJ. Vibration perception threshold-a valuable assessment of neural dysfunction in people with diabetes. Diabetes Metab Res Rev, 2006; 22(5):411-9.https://doi.org/10.1002/dmrr.657

Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. Nutrients, 2014; 6(4):1406-23.https://doi.org/10.3390/nu6041406

Goldstein DJ, Lu Y, Detke MJ, Lee TC, Iyengar S. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain, 2005; 116(1- 2):109-18.https://doi.org/10.1016/j.pain.2005.03.029

Grazia D, Sara R, Raffaella L, Daniele C, Margherita M, Erika S, Roberto E, Giuseppe L. Diagnostic criteria for small fibre neuropathy in clinical practice and research. Brain, 2019; 142(12):3728-36. https://doi.org/10.1093/brain/awz333

Hossain MM, Shoaib SM, Mallick R, Hore R, Tanmy TT. An assessment of present status and related complications of Diabetes Mellitus (DM) at port city Chittagong in Bangladesh. Stand Res J Med Med Sci, 2013; 1:6-11.

Jain D, Bansal MK, Dalvi R, Upganlawar A, Somani R. Protective effect of diosmin against diabetic neuropathy in experimental rats. J Integr Med, 2014; 12(1):35-41.https://doi.org/10.1016/S2095-4964(14)60001-7

Joharchi K, Memari M, Azargashb E, Saadat N. Efficacy and safety of duloxetine and Pregabalin in Iranian patients with diabetic peripheral neuropathic pain: a double-blind, randomized clinical trial. Journal of Diabetes and Metabolic Disorders., 2019; 18(2):575--82.https://doi.org/10.1007/s40200-019-00427-w

Khwaja GA, Chaudhry N. Current and emerging therapies for painful diabetic neuropathies. J Indian Acad Clin Med, 2007; 8:53-64.

Kitto KF, Haley JE, Wilcox GL. Involvement of nitric oxide in spinally mediated hyperalgesia in the mouse. Neurosci Lett, 1992; 148(1- 2):1-5.https://doi.org/10.1016/0304-3940(92)90790-E

Koltezenburg M, Scadding J. Neuropathic pain. Curr Opin Neurol, 2001; 14(5):641-7. https://doi.org/10.1097/00019052-200110000-00014

Lesser H, Sharma U, LaMoreaux L, Poole RM. Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology, 2004; 63(11):2104-10. https://doi.org/10.1212/01.WNL.0000145767.36287.A1

Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA, 2001; 286(3):327-34.https://doi.org/10.1001/jama.286.3.327

Ramirez MA, Borja NL. Epalrestat: an aldose reductase inhibitor for the treatment of diabetic neuropathy. Pharmacotherapy, 2008; 28(5):646-55.https://doi.org/10.1592/phco.28.5.646

Raskin J, Pritchett YL, Wang F, D'Souza DN, Waninger AL, Iyengar S, Wernicke JF. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med, 2005; 6(5):346-56.https://doi.org/10.1111/j.1526-4637.2005.00061.x

Richter RW, Portenoy R, Sharma U, Lamoreaux L, Bockbrader H, Knapp LE. Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain Res. , 2005; 6(4):253--60.https://doi.org/10.1016/j.jpain.2004.12.007

Rosenstock J, Tuchman M, LaMoreaux L, Sharma U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain, 2004; 110(3):628-38.
https://doi.org/10.1016/j.pain.2004.05.001

Ryle C, Donaghy M. Non-enzymatic glycation of peripheral nerve proteins in human diabetics. J Neurol Sci, 1995; 129(1):62-8.https://doi.org/10.1016/0022-510X(94)00251-I

Singh GA, Bhardwaj S, Pandita D, Lather V, Singh Sekhon B. Updates on aldose reductase inhibitors for management of diabetic complications and non-diabetic diseases. Mini Reviews in Medicinal Chemistry., 2016; 16(2):120--62.https://doi.org/10.2174/1389557515666150909143737

Sundaram M, Kavookjian J, Patrick JH, Miller LA, Madhavan SS, Scott VG. Quality of life, health status and clinical outcomes in Type 2 diabetes patients. Qual Life Res, 2007; 16(2):165-77.
https://doi.org/10.1007/s11136-006-9105-0

Syed I. Glycated haemoglobin; past, present, and future are we ready for the change. Diabetes, 2011; 11:12.

Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. , 2014; 155(4):654--62. https://doi.org/10.1016/j.pain.2013.11.013

Veves A, Backonja M, Malik RA. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med, 2008; 9:660-74.https://doi.org/10.1111/j.1526-4637.2007.00347.x

Vinik A. The approach to the management of the patient with neuropathic pain. J Clin Endocrinol Metab, 2010; 95(11):4802-11.https://doi.org/10.1210/jc.2010-0892

Yagihashi S, Yamagishi SI, Wada R. Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs and symptoms. Diabetes Res Clin Pract, 2007; 77(3):184-9.
https://doi.org/10.1016/j.diabres.2007.01.054

Zychowska M, Rojewska E, Przewlocka B, Mika J. Mechanisms and pharmacology of diabetic neuropathy-experimental and clinical studies. Pharmacol Rep, 2013; 65(6):1601-10.https://doi.org/10.1016/S1734-1140(13)71521-4

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