2024 American Academy of Neurology Abstract Website

Vinay Suresh¹, Debankur Dey³, Malavika Jayan⁴, Muhammad Aaqib Shamim⁵, Shiva Gupta¹, Dabbara Ramana⁶, Tirth Dave⁷, Rahul Jena⁸, Muneeb Ahmad Muneer⁹, Bishal Dhakal¹⁰, Shankhaneel Ghosh¹¹, Amogh Verma¹², Archit Garg¹³, Muhammad Muzammil¹⁴, Mainak Bardhan¹⁵, Hardeep Malhotra², Neeraj Kumar², Himel Mallick¹⁶, Bhaskar Roy¹⁷
¹King George's Medical University, ²Department of Neurology, King George's Medical University, ³Medical College and Hospital Kolkata, ⁴Bangalore Medical College and Research Institute, ⁵Department of Pharmacology, All India Institute of Medical Science - Jodhpur, ⁶Osmania Medical College, Hyderabad, India, ⁷Bukovinian State Medical University, Ukraine, ⁸Bharati Vidyapeeth Medical College, Pune, ⁹Allama Iqbal Medical College, Lahore, Pakistan, ¹⁰Nepalese Army Institute of Health Sciences, ¹¹IMS and SUM Hospital, ¹²Rama Medical College Hospital and Research Centre, Hapur, ¹³Shaheed Hasan Khan Mewati, Government Medical College , Nuh, Haryana, ¹⁴Dow University of Health Sciences, ¹⁵Neuro Medical Oncology, Miami Cancer Institute,Baptist Health South Florida, USA, ¹⁶Department of Statistics and Data Science, Weill Cornell Medical College, USA, ¹⁷Department of Neurology, Yale University

Objective:

To evaluate the efficacy of pharmacological interventions in managing pain in diabetic peripheral neuropathy (DPN) through a network meta-analysis (NMA) and systematic review.

Background:

Over 50% of patients with diabetes eventually develop peripheral neuropathy, which can be painful and disabling. The optimal choice of pharmacotherapy for achieving pain relief remains unclear, and a comprehensive review of evidence incorporating recent data is warranted to establish effective pain management strategies and compare their efficacies.

Design/Methods:

A thorough systematic search was conducted in the databases: PubMed/MEDLINE, Cochrane, EMBASE, and ClinicalTrials.gov databases to identify RCTs that focused on interventions for DPN. The search included trials from the earliest available date up to September 2023. The primary outcome considered was a 50% reduction in pain. Pairwise meta-analysis and network meta-analysis were performed using the frequentist approach to obtain direct and indirect comparisons of each measure in terms of risk ratios.

Results:

A total of 57 RCTs with 13,132 patients and 43 different pharmacological interventions provided data on pain reduction of 50% or more (the largest analysis to date). Compared to placebo, more than 50% decrease in pain intensity was only seen with Pregabalin [RR 1.35; 1.05-1.73],Duloxetine [RR 1.51;1.10-2.05], Gabapentin [RR 1.99;1.07-3.68], and Oxcarbazepine [RR 2.55;95% CI: 1.15-5.65] in this order of increasing efficacy. However, no significant difference in efficacy between the four drugs was observed.

Conclusions:

This preliminary analysis confirms that Pregabalin, Duloxetine, Gabapentin, and Oxcarbazepine have substantial pain relief in diabetic peripheral neuropathy compared to placebo. Further comprehensive and in-depth analysis is currently underway.