Comparison of the Efficacy of Duloxetine and Pregabalin in Pain Relief Associated with Diabetic Neuropathy

Abstract

Introduction Painful diabetic peripheral neuropathy (PDPN) complicates 25% of type II diabetes mellitus. It has a profound impact on diabetes-related morbidity and worsens the quality of life. Both pregabalin and duloxetine may be indicated for PDPN. In this study, the efficacy of duloxetine and pregabalin was compared in patients with PDPN. Methods It was a single-centre open-label study conducted with patients of diabetes mellitus type II diagnosed with PDPN. Patients were randomized to receive 60 mg/daily duloxetine or 300 mg/daily pregabalin. Pain scores were recorded using visual analogue scale (VAS) on day 0, week 4, and week 12. Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY). Results In the duloxetine group, the mean VAS score decreased from 6.81 ± 0.91 to 4.01 ± 1.12 with 12 weeks of therapy (p <0.0001). In the pregabalin group, the mean VAS score decreased from 6.99 ± 1.12 to 4.91 ± 0.82 with 12 weeks of therapy (p <0.0001). At 12 weeks, duloxetine showed lower VAS scores than pregabalin (p <0.0001). In the duloxetine group, the mean change in VAS score over time was-2.80 and in the pregabalin group, the mean change was-2.80. Adverse events were reported in 17.9% of the participants. Lethargy/somnolence (8.1%) and peripheral edema (3.4%) were commonly reported in the pregabalin group and constipation (6.9%) and orthostatic hypotension (4.6%) were commonly reported in the duloxetine group. Conclusions Duloxetine at a daily fixed dose of 60 mg is efficacious in the relief of neuropathic pain. Pregabalin also showed a comparable outcome. Both duloxetine and pregabalin have a promising safety profile and are well-tolerated.

A Prospective Observational Study Comparing the Efficacy and Safety of Duloxetine and Pregabalin in Diabetic Peripheral Neuropathic Pain

“…In our study, DLX was more effective than PGB in reducing the neuropathic pain in diabetes; however, the difference was not statistically significant. Similar findings regarding the efficacy of DLX and PGB in diabetic peripheral neuropathic pain were reported by Shahid et al [ 16 ]. Goldstein and colleagues compared the dose-related efficacy of DLX for peripheral neuropathic pain.…”

An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy

“…Synergistic inhibition of these neurotransmitters causes less transmission of pain signals from periphery to CNS. A number of preclinical and clinical trials have shown increased tolerance to pain with reduced pain symptoms in diabetic-induced painful neuropathy [ 125 – 127 ]. Pathogenic mechanism involving NF- κ B can cause spinal glial cells to secrete active substances and cytokines that can cause a sustained neuropathic pain.…”

“…For the management of painful diabetic neuropathy, pregabalin is a first line of treatment according to international guidelines. Dose-dependent studies have been conducted on pregabalin drug to quantify the pain intensity in diabetes-induced neuropathies [ 125 , 132 , 133 ]. Pain reduction was less than 50% in 3 : 10 patients taking 300/600 mg pregabalin daily as compared to 2 : 10 with placebo.…”

A randomized control trial of duloxetine and gabapentin in painful diabetic neuropathy

“…9 Pregabalin has been compared with duloxetine in previous trials. 10,11 A study done by Shahid et al 10 found statistically significant reduction in pain scores over time from baseline to 12 weeks (P < 0.001) with both duloxetine and pregabalin. Devi et al, 11 evaluated clinical efficacy of gabapentin, duloxetine, and pregabalin in PDN and revealed a significant reduction in Visual Analogue Scale (VAS) at the end of 12 weeks in all three groups (P < 0.05) but no significant difference between the groups.…”