Real world treatment patterns among patients with painful diabetic peripheral neuropathy in the United States.

OBJECTIVE

This study analyzes real-world treatment patterns among patients newly initiating treatment for painful diabetic peripheral neuropathy using a contemporary dataset in the United States.

METHODS

A retrospective study using the MarketScan database (January 1, 2016, to June 30, 2023) identified adults newly prescribed pain medication(s) used to treat neuropathic pain within 60 days of a diabetic peripheral neuropathy diagnosis. Patients with prior medication, conditions with similar treatment indications, cancer, or major surgery were excluded. Treatment patterns over a 12-month period and variable-length follow-up (four sequential treatment episodes) were captured, including treatment type, dosage, adherence, discontinuation (≥90-day gap), and switching.

RESULTS

Among 22 955 patients identified, 98.5% initiated monotherapy treatment for painful diabetic peripheral neuropathy. The majority initiated treatment with gabapentinoids (gabapentin 59.0%; pregabalin 5.3%), followed by opioids (tramadol 15.1%, oxycodone 7.0%), and antidepressants (duloxetine 5.2%). Among patients initiating gabapentin, pregabalin, or duloxetine, most were prescribed daily doses below recommended levels (79% gabapentin, 91% pregabalin, 61% duloxetine), and the majority (81%-96%) did not increase their dose. Adherence was low. Over 50% discontinued their initial treatment within 3 months, and approximately 75% discontinued in the 12-month follow-up period, with fewer than 25% switching to another medication. When evaluating treatment patterns across sequential treatment episodes, almost 65% discontinued all pain medications and did not receive subsequent treatment by the fourth treatment episode.

CONCLUSIONS

High rates of treatment discontinuation and suboptimal adherence likely indicate challenges with tolerability and insufficient pain relief associated with current therapies for painful diabetic neuropathy. These findings emphasize the limitations of existing treatment options and highlight the unmet need for more effective and better-tolerated treatments for these patients.