Study of Epalrestat in Diabetic Distal Symmetric Polyneuropathy and correlation of its therapeutic efficacy with erythrocyte sorbitol levels : A step towards Precision Medicine
Abstract
Aims : Diabetic Distal Symmetric Polyneuropathy (DSPN), despite being the most common and a disabling diabetic complication, remains difficult to treat. It has led to rekindle our interest in Epalrestat which has the potential to alter the natural history of the disease. The present study was designed to evaluate the efficacy of Epalrestat in DSPN and to corelate its therapeutic efficacy with baseline erythrocyte sorbitol levels. Methods : 100 patients with duration of diabetes more than five years and Diabetic Neuropathy Symptom Score (DNSS) ≥ 1 were included. They were divided into two groups of 50 patients each : Group 1 (received Tablet Epalrestat 150 mg once a day), Group 2 (received placebo). Baseline Diabetic Neuropathy Symptom Score (score out of 4), Numeric Pain Intensity Scale (score out of 10), Monofilament score (score out of 10), Vibration Perception Threshold (VPT) by Sensitometer and erthyrocyte sorbitol levels (by ELISA) were recorded. Same parameters were repeated at three months follow up visit. Results : Epalrestat was overall more effective than placebo in improving the symptoms as well as in improving the quantitative sensory nerve function measured by sensitometer The improvement in all the parameters positively correlated with baseline erythrocyte sorbitol levels. Conclusions : Epalrestat offers a ray of hope in the treatment of DSPN patients who have high baseline erythrocyte sorbitol levels and thus can be a useful tool in predicting the response to drug.
Keywords: Diabetic peripheral neuropathyEpalrestatSorbitolVibration perception threshold.
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