Efficacy and Safety of Duloxetine Compared with Placebo for Diabetic Neuropathy Pain:Meta-Analysis

Abstract

Background : Duloxetine is relatively considered as a treatment for diabetic neuropathy pain due it is balanced and potent reuptake inhibitor of both serotonin and nor epinephrine where these neurotransmitters play a great in pain inhibition. Materials and Methods : We searched DLX related articles in Pubmed, Cochrane and Embase from 2005 to 2010. 158 articles were found after through search out of which 68 articles were case reports, reviews and meta-analysis, 40 studies were clinical trials but not efficient data was available, 45 studies were RCTs but not related to our topic. Only 5 RCTs included after exclusion. We then performed the meta-analysis of the studies which met our eligibility criteria we performed fixed effect model network meta-analysis to analyze the efficacy of DLX compare to placebo. We chose diabetic neuropathy duration, diabetes mellitus duration, types of diabetes and DLX with regard to MNSI scale. Results : 5 published RCTs were included in this meta-analysis no significant difference observed for DLX and DND [(SD mean difference 0.22 (95%CI -0.16 to 0.60); P=0.25)], on diabetes mellitus duration for HbA1c and fasting blood glucose (FBG) [(SD mean difference -0.00 (95%CI-0.087 to 0.87); P=1.00)] and on types of diabetes [(COR 1.00 (95% CI 0.73 to 1.38; P=0.98)] and [(OR 1.00 (95% CI 0.72 to 1.37); P=0.98)]. DLX shown to have significant efficacious compared to placebo for MNSI (95% CI -0.37 to - 0.03); P=0.02)]. Conclusion : In the fixed effect model analyses of DLX, showed similar efficacy to placebo for efficacy parameters, except on MNSI scale but not clinically relevant.