Evaluating the efficacy and safety of duloxetine and gabapentin in managing diabetic neuropathy: A systematic review and meta-analysis.

IF 1.5 Q4 CLINICAL NEUROLOGY

British Journal of Pain Pub Date : 2025-08-06 DOI:10.1177/20494637251365690

Ahmed A Attar, Mumen H Halabi, Ehab T Barnawi, Gadi K Sindi, Ammar A Altayeb, Fadel T Fadel, Lama H Alsubhi, Ghadah Y Alsamiri, Ahmad S Alsabban

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引用次数: 0

Abstract

Background and objective: Painful diabetic neuropathy (PDN) is a common complication of diabetes, characterized by significant pain and functional impairment. Gabapentin and duloxetine are standard treatments. This study compared their efficacy in alleviating pain, improving clinical global impression of change (CGIC), reducing sleep interference, enhancing response rates, and assessing safety.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. A search of Embase, Medline, ScienceDirect, Scopus, Web of Science, and Cochrane databases through May 2024 identified randomized controlled trials comparing gabapentin and duloxetine for PDN. Risk of bias was assessed using the Cochrane RoB2 tool. Data on pain, CGIC, sleep interference, responder rates, and adverse events were analyzed using a random-effects model, with results presented as standardized mean differences and risk ratios with 95% confidence intervals.

Results: Six RCTs with 526 patients (44% female) were included. There was no significant difference between duloxetine and gabapentin in relieving pain (SMD = -0.16, 95% CI [-0.36, 0.03], p = .10, I² = 66%). No significant differences were observed in the overall effect of CGIC (MD = 0.01, 95% CI [-0.07, 0.09], p = .79, I² = 0%), or sleep interference (MD = -0.07, 95% CI [-0.36, 0.23], p = .67, I² = 39%); However, duloxetine showed superiority at week 1 for CGIC (MD = 0.56, 95% CI [0.18, 0.94], p = .003), and week 8 for sleep interference (MD = -0.40, 95% CI [-0.79, -0.01], p = .04, I² = 0%), while gabapentin was superior at week 1 in sleep interference (MD = 0.75, 95% CI [0.11, 1.39], p = .02). No significant differences were observed in responder rates or adverse events.

Conclusion: Gabapentin and duloxetine are effective for PDN, with distinct advantage at different time points. Personalized treatment is recommended, and future research should assess long-term efficacy in diverse populations.

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评价度洛西汀和加巴喷丁治疗糖尿病神经病变的有效性和安全性：一项系统回顾和荟萃分析。

背景与目的：疼痛性糖尿病神经病变（pain diabetes neuropathy， PDN）是糖尿病的常见并发症，以明显的疼痛和功能损害为特征。加巴喷丁和度洛西汀是标准治疗方法。本研究比较了它们在缓解疼痛、改善临床总体印象变化（CGIC）、减少睡眠干扰、提高反应率和评估安全性方面的疗效。方法：根据PRISMA指南进行系统回顾和荟萃分析。通过Embase、Medline、ScienceDirect、Scopus、Web of Science和Cochrane数据库到2024年5月的检索，发现了比较加巴喷丁和度洛西汀治疗PDN的随机对照试验。使用Cochrane RoB2工具评估偏倚风险。使用随机效应模型分析疼痛、CGIC、睡眠干扰、应答率和不良事件的数据，结果显示为标准化平均差异和95%置信区间的风险比。结果：纳入6项随机对照试验，526例患者（44%为女性）。度洛西汀与加巴喷丁在缓解疼痛方面无显著差异（SMD = -0.16, 95% CI [-0.36, 0.03], p = 0.10, I2 = 66%）。CGIC的总体效果（MD = 0.01, 95% CI [-0.07, 0.09], p = 0.79, I2 = 0%）或睡眠干扰（MD = -0.07, 95% CI [-0.36, 0.23], p = 0.67, I2 = 39%）无显著差异；然而，度洛西汀在第1周治疗CGIC (MD = 0.56, 95% CI [0.18, 0.94], p = 0.003)，第8周治疗睡眠干扰（MD = -0.40, 95% CI [-0.79, -0.01], p = 0.04, I2 = 0%），而加巴喷丁在第1周治疗睡眠干扰（MD = 0.75, 95% CI [0.11, 1.39], p = 0.02）方面表现优越。在应答率或不良事件方面没有观察到显著差异。结论：加巴喷丁与度洛西汀治疗PDN均有效，且在不同时间点优势明显。建议个体化治疗，未来的研究应评估不同人群的长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Pain CLINICAL NEUROLOGY-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.