Combination Of Methylcobalamin Research Articles

A PHARMACOECONOMIC EVALUATION OF DRUGS IN PATIENTS OF PAINFUL DIABETIC NEUROPATHY

Aims and objectives: To study the effect of methylcobalamin, the combination of methylcobalamin with pregabalin, and methylcobalamin with duloxetine in patients with painful diabetic neuropathy after comparing the safety, tolerability, and economic implications of all three study groups. Methods: The present study was a prospective, open-labeled, interventional, randomized, and parallel-group study conducted on 100 patients of painful diabetic nephropathy from the outpatient department of the hospital who were recruited after obtaining informed consent. The permission for the study was taken from the Institutional Ethical Committee. The patients were randomized into three study groups: A, B, and C, on methylcobalamin, methylcobalamin, pregabalin, methylcobalamin, and duloxetine. Results: The mean value of the price of each tablet from all the brands of the respective drugs and finally calculating the cost for the whole 3 months which comes out to be Rs. 797.4 for group A, Rs. 1940.4 for group B, and Rs. 1163.7 for group C. The cost of the entire treatment and the effect produced in terms of the difference in the visual analog scale score from day 1 to the end of week 12 which are 0.58 for group A, 3.82 for group b, and 4.17 for group C. Conclusion: The primary purpose of the pharmacoeconomic evaluation is not to directly alter the therapeutic decisions of the physicians but to help the physicians, pharmacists, and policymakers to make informed decisions about whether the cost and extra benefits of the new drug are meaningful within the given budget.

Acute Onset Peripheral Neuropathy in a Patient with Scrub Typhus

The neurological complications of scrub typhus can have a wide spectrum of presentations involving both central and peripheral nervous system, meningoencephalitis and meningitis being the most common. Involvement of the peripheral nervous system in scrub infection is not commonly reported, here we present a case of A 70-year-old male diagnosed with scrub typhus fever and presented with peripheral neuropathy. Duloxetine and methyl cobalamin combination along with gabapentin were used for management and the patient was partially improved gradually over a period of six days. Keywords: scrub typhus, scrub infection, scrub typhus fever, orientia tsutsugamushi.

Prostaglandin E1 plus methylcobalamin combination therapy versus prostaglandin E1 monotherapy for patients with diabetic peripheral neuropathy: A meta-analysis of randomized controlled trials.

Background:Prostaglandin E1 (P) or methylcobalamin (M) treatment has been suggested as a therapeutic approach for diabetic peripheral neuropathy (DPN) in many clinical trial reports. However, the combined effects of 2 drugs still remain dubious.Objective:The aim of this report was to evaluate the efficacy of M plus P (M + P) for the treatment of DPN compared with that of P monotherapy, in order to provide a reference resource for rational drug use.Methods:Randomized controlled trials (RCTs) of M + P for DPN published up to September 2017 were searched. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I2 test. Subgroup and sensitivity analyses were also performed. The outcomes measured were as follows: the clinical efficacy, median motor nerve conduction velocities (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and adverse effects.Results:Sixteen RCTs with 1136 participants were included. Clinical efficacy of M + P combination therapy was significantly better than P monotherapy (fifteen trials; RR 1.25, 95% CI 1.18–1.32, P < .00001, I2 = 27%). Compared with P monotherapy, the pooled effects of M + P combination therapy on nerve conduction velocity were (MD 6.29, 95% CI 4.63–7.94, P < .00001, I2 = 90%) for median MNCV, (MD 5.68, 95% CI 3.53–7.83, P < .00001, I2 = 94%) for median SNCV, (MD 5.36, 95% CI 3.86–6.87, P < .00001, I2 = 92%) for peroneal MNCV, (MD 4.62, 95% CI 3.48–5.75, P < .00001, I2 = 86%) for peroneal SNCV. There were no serious adverse events associated with drug intervention.Conclusions:M + P combination therapy was superior to P monotherapy for improvement of neuropathic symptoms and NCVs in DPN patients. Moreover, no serious adverse events occur in combination therapy.

Comparison of Treatment for Metabolic Disorders Associated with Autism:Reanalysis of Three Clinical Trials.

Autism spectrum disorder (ASD) affects about 1 in 45 individuals in the United States, yet effective treatments are yet to be defined. There is growing evidence that ASD is associated with abnormalities in several metabolic pathways, including the inter-connected folate, methylation and glutathione pathways. Several treatments that can therapeutically target these pathways have been tested in preliminary clinical trials. The combination of methylcobalamin (mB12) with low-dose folinic acid (LDFA) and sapropterin, a synthetic form of tetrahydrobiopterin (BH4) have been studied in open-label trials while high-dose folinic acid has been studied in a double-blind placebo controlled trial. All of these treatments have the potential to positively affect folate, methylation and glutathione pathways. Although the effect of mB12/LDFA and BH4 on methylation and glutathione metabolism have been examined in the open-label studies, these changes have not been compared to controls who received a placebo in order to account for the natural variation in the changes in these pathways. Furthermore, the recent study using high-dose folinic acid (HDFA) did not analyze the change in metabolism resulting from the treatment. Thus, we compared changes in methylation and glutathione metabolism and biomarkers of chronic oxidative stress as a result of these three treatments to individuals receiving placebo. In general, mB12/LDFA treatment had a significant effect on glutathione and cysteine metabolism with a medium effect size while BH4 had a significant effect on methylation and markers of chronic oxidative stress with a large effect size. HDFA treatment did not significantly influence biomarkers of methylation, glutathione or chronic oxidative stress. One caveat was that participants in the mB12/LDFA and BH4 studies had significantly worse markers of glutathione metabolism and chronic oxidative stress at baseline, respectively. Thus, the participants selected in these two clinical trials may have been those with the most severe metabolic abnormalities and most expected to respond to these treatments. Overall this study supports the notion that metabolic abnormalities in individuals with ASD may be amenable to targeted treatments and provide some insight into the mechanism of action of these treatments.

Patient with Postthoracotomy Pain

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia. Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases. This review contains 1 table, and 57 references. Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery

The Effect of Pregabalin and Methylcobalamin Combination on the Chronic Postthoracotomy Pain Syndrome

Chronic postthoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. We aimed to determine the safety and efficacy of pregabalin and methylcobalamin combination (PG-B12) in comparison with diclofenac potassium (DP) in patients with CPTP. One hundred consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively randomly assigned and evaluated. Fifty patients were given PG-B12 and another 50 patients were given DP treatment. Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scorings were performed previous to the treatment (day 0) and on the 15th, 30th, 60th, and 90th days. Adverse events were questioned. The mean ages were 58.7 ± 12.2 and 54.6 ± 14.5 years, and the mean durations of pain were 4.01 ± 1.04 and 3.8 ± 1.02 months, respectively. The number of patients with a VAS score less than 5 at the latest follow-up (VAS90 < 5) was 44 (88%) and 18 (36%) in the PG-B12 and DP groups, respectively (p < 0.05). Forty-four patients (88%) in the PG-B12 group and 16 patients (32%) in the DP group had a LANSS score less than 12 at the latest follow-up (p < 0.05). Minor adverse events that did not mandate discontinuation of the treatment were observed in 14 patients (28%) in the PG-B12 group and 2 patients (4%) in the DP group. PB-B12 is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported by multidisciplinary studies with larger sample sizes and longer follow-ups.

The effects of gliclazide, methylcobalamin, and gliclazide + methylcobalamin combination therapy on diabetic peripheral neuropathy in rats

AimsThis study investigated the efficacies of gliclazide (GLZ), methylcobalamin (MCA), and GLZ+MCA combination therapy on DPN by evaluating the treatment-related changes in peripheral nerve function, the polyol pathway, and oxidative stress in the sciatic nerve of streptozotocin-induced diabetic rats. Materials and methodsThe rat model of streptozotocin-induced diabetes was orally given GLZ (25mg/kg/day), MCA (175μg/kg/day), and GLZ+MCA (25mg/kg/day+175μg/kg/day) combination therapy for 8weeks, in order to observe its effects on the motor nerve conduction velocity (MNCV), on the activities of Na+, K+-ATPase, aldose reductase(AR), AR mRNA expression, on the polyol contents, antioxidative enzyme activities and peroxidation products in the sciatic never tissue. Key findingsMost of the indicators of DPN, such as delayed MNCV, altered/damaged nerve structure, inhibited Na+,K+-ATPase activity, enhanced AR activity and AR mRNA expression, increased polyol contents, altered Cu,Zn-superoxide dismutase, catalase, and glutathione-peroxidase activities, and elevated malondialdehyde level in the sciatic nerves of the diabetic rats, were significantly ameliorated by treatment with either GLZ or MCA. Moreover, the combination of GLZ and MCA was found to enhance the curative effect on DPN in parts of above-mentioned parameters as compared to monotherapy. SignificanceMonotherapy with GLZ or MCA, and especially the combined application of GLZ and MCA, could be efficient therapeutic strategies for combating experimental DPN in diabetic rats.

Post-Marketing Surveillance of Fixed Dose Combination of Methylcobalamin, Alpha Lipoic Acid, Folic Acid, Biotin, Benfotiamine &amp;amp; Vitamin B6-Nutripathy for the Management of Peripheral Neuropathy

Background: Peripheral neuropathy is a commonly encountered troublesome condition which is often disabling & worsens when left untreated. Traditional neuropathic pain medications primarily provide symptomatic relief; however, the pathogenesis of nerve damage remains unresolved. Extensive literature survey reveals that patients with peripheral neuropathy experience significant benefits with the use of B-vitamins like methylcobalamin (B12), folic acid (B9), biotin (B7), benfotiamine (B1) and pyridoxine (B6). The other well documented antineuropathic agents include alpha lipoic acid, glutathione, omega fatty acids, myoinositol, certain trace elements, etc. Materials and Methods: A multicentre, prospective, open-label, non-comparative clinical study was carried out in 497 patients with peripheral neuropathy. A fixed dose combination of methylcobalamin, alpha lipoic acid (ALA), folic acid, biotin, benfotiamine & vitamin B6 capsule was orally administered once daily for 12 weeks. Results: Treatment led to significant reduction from baseline score in various neuropathy symptoms from the 4th week itself. After 12 weeks of treatment, the mean pain score declined by 78.0%, numbness by 92.1% and muscle weakness by 96.9%. Also, there was 96.0% & 99.2% reduction in tingling & burning sensation respectively. No serious adverse events were reported.Conclusion: The current study confirms that fixed dose combination of methylcobalamin, ALA, folic acid, biotin, benfotiamine & vitamin B6 is effective & well tolerated in the management of peripheral neuropathy.

Efficacy and tolerability of a fixed dose combination of methylcobalamin and pregabalin in the management of painful neuropathy

Pregabalin and Methylcobalamine are both capable reliving the symptoms of peripheral neuropathy but their effectiveness when used in a fixed dose combination still remains a subject of evaluation, especially in the orthopaedic setting. This post marketing surveillance study evaluates efficacy and tolerability of a fixed dose combination of Methylcobalamin 750 μg and Pregabalin 75 mg in the management of the same. The fixed dose combination of was prescribed for 4 weeks to the selected patients at 300 orthopaedic clinics all over India involving 1327 patients. Pain was assessed on a 10 point Numerical Pain Intensity Scale while physicians and patients overall assessment of efficacy and tolerability was done on a four-point scale. Results demonstrated a reduction in the pain which was evidenced by a visual analogue score of 38.87 and 73.99% at second and fourth week respectively. Eighty seven per-cent doctors and 88.11% patients expressed response to therapy as good to excellent. Tolerability was expressed as good to excellent by 81.48% of patients. Adverse events were of mild severity. Thus the fixed dose combination was efficacious and well tolerated in neuropathic pain with minimal adverse effects.