Efficacy and safety of pregabalin and duloxetine in painful diabetic neuropathy: a systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVE

Pregabalin (PGB) and duloxetine (DLX) are commonly used first-line medications in the clinical management of painful diabetic neuropathy (PDN), yet high-quality comparative evidence is limited. This meta-analysis evaluates the comparative efficacy and safety of PGB versus DLX, focusing on efficacy outcomes such as pain reduction and mental health, and safety outcomes including adverse events in PDN patients.

METHOD: We searched electronic databases for relevant studies assessing the efficacy and safety of PGB and DLX in PDN. The primary outcomes were the mean change of the Visual Analog Scale (VAS) and the improvement ratio for patients achieving ≥ 50% pain reduction. Secondary outcomes include the Numeric Rating Scale (NRS) for pain, the Short Form 12 Health Survey (SF-12), and related adverse events. A random-effects meta-analysis was performed to evaluate these outcomes.

RESULTS

We analyzed 19 studies involving 4483 patients. PGB significantly reduced VAS scores at 24 weeks (MD = -0.38; 95% confidence interval [CI], -0.45 to -0.31; P < .0001) and decreased the mental component of SF-12 compared to DLX (MD = -3.36; 95% CI, -6.64 to -0.07; P = .05) and lower rates of achieving >50% pain reduction (risk ratio = 0.88; 95% CI, 0.79 to 0.98; P = .03). Regarding safety, PGB showed a lower incidence of several adverse events, including anorexia, decreased appetite, diarrhea, nausea, and vomiting. However, no significant differences in VAS scores were observed between PGB and DLX at 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, and 12 weeks, with similar results observed in NRS.

CONCLUSION

We found that PGB and DLX showed similar efficacy in relieving PDN. Ultimately, the 2 drugs' similar effectiveness and different safety profiles highlight the importance of considering patient-specific factors when choosing the appropriate treatment.