A comparative study of the effectiveness and safety of pregabalin and duloxetine in the treatment of chemotherapy-induced neuropathic pain
, 1, 2
Abstract
Background: Chemotherapeutic medicines are among the several medication types that can cause peripheral neuropathy, a serious disorder marked by symmetrical, distal damage to the peripheral nerves. Chemotherapy-induced peripheral neuropathy (CIPN) is a significant problem that is becoming more prevalent as oncological treatments that use potentially neurotoxic chemotherapy improve the prognosis and cure of cancer. CIPN can need dose decrease or discontinuance, which can have an adverse effect on survival. Relieving the patient from CIPN is required because it enhances their quality of life as well as their mental and physical health.
Patients and methods: The patients who were diagnosed with chemotherapy-induced neuropathic pain were randomized into two groups after obtaining written informed consent. Group D received duloxetine 30 mg orally daily in the 1st week followed by 30 mg twice daily until 3 weeks and Group P received pregabalin 75 mg orally daily in the 1st week followed by 75 mg twice daily until 3 weeks. The intensity of pain was measured using the NRS (Numerical Rating Scale) and the DN4 questionnaire was used to evaluate the neuropathic component. Changes in pain score and neuropathic component were assessed at baseline and then at the 2nd and 4th week of follow-up. Data was collected and analyzed using SPSS 20.0 software at a level of significance p < 0.05.
Results: At baseline, the mean ± standard deviation (SD) of the NRS score in Group D was 7.12 ± 0.89; in Group P was 7.01 ± 0.66 at the end of the study 4th week, the mean ± SD of the NRS score in Group D was 4.04 ± 0.98; in Group P was 5.18 ± 0.64. At baseline, the mean ± SD of the DN4 score in Group D was 7.21 ± 0.80; in Group P was 6.93 ± 0.85 at the end of the study 4th week, the mean ± SD of the DN4 score in Group D was 4.73 ± 0.42; in Group P was 5.13 ± 0.82. The reduction in NRS scores and DN4 scores at the end of the study (4th weeks) when compared to baseline scores were statistically significant in each group (p < 0.0001).
Conclusions: Both pregabalin and duloxetine are effective in improving the CIPN in patients with cancers. Both the drugs were well tolerated with mild side effects like headache, drowsiness, and sedation. However, duloxetine was found to be more favorable with fewer side effects than pregabalin.
Keywords: duloxetinepregabalinpaincancerchemotherapy-induced neuropathic pain
References
- Burgess J, Ferdousi M, Gosal D, et al. Chemotherapy-Induced peripheral neuropathy: epidemiology, pathomechanisms and treatment. Oncol Ther. 2021; 9(2): 385–450.
- Zafari N, Velayati M, Maftooh M, et al. Mechanism-based pharmacological management of chemotherapy-induced neuropathic pain from preclinical studies to clinical prospective: platinum-based drugs, taxanes, and vinca alkaloids. Curr Pharm Des. 2023; 29(16): 1245–1265.
- Kerckhove N, Collin A, Condé S, et al. Long-term effects, pathophysiological mechanisms, and risk factors of chemotherapy-induced peripheral neuropathies: a comprehensive literature review. Front Pharmacol. 2017; 8: 86.
- Zajączkowska R, Kocot-Kępska M, Leppert W, et al. Mechanisms of chemotherapy-induced peripheral neuropathy. Int J Mol Sci. 2019; 20(6): 1451.
- Tanay MAL, Armes J, Ream E. The experience of chemotherapy-induced peripheral neuropathy in adult cancer patients: a qualitative thematic synthesis. Eur J Cancer Care (Engl). 2017; 26(5).
- Yoon SoY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med. 2018; 33(6): 1058–1069.
- Maihöfner C, Diel I, Tesch H, et al. Chemotherapy-induced peripheral neuropathy (CIPN): current therapies and topical treatment option with high-concentration capsaicin. Support Care Cancer. 2021; 29(8): 4223–4238.
- Merheb D, Dib G, Zerdan MB, et al. Drug-induced peripheral neuropathy: diagnosis and management. Curr Cancer Drug Targets. 2022; 22(1): 49–76.
- Manjushree N. A Compcive study of the efficacy and safety of gabapentin and pregabalin in the treatment of chemotherapy induced neuropathic pain, doctoral dissertation, Rajiv Gandhi University of Health Sciences (India).
- Hung HW, Liu CY, Chen HF, et al. Impact of chemotherapy-induced peripheral neuropathy on quality of life in patients with advanced lung cancer receiving platinum-based chemotherapy. Int J Environ Res Public Health. 2021; 18(11): 5677.
- Fradkin M, Batash R, Elmaleh S, et al. Management of peripheral neuropathy induced by chemotherapy. Curr Med Chem. 2019; 26(25): 4698–4708.
- Wong DT, Bymaster FP, Mayle DA, et al. LY248686, a new inhibitor of serotonin and norepinephrine uptake. Neuropsychopharmacology. 1993; 8(1): 23–33.
- Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology. 2001; 25(6): 871–880.
- Trivedi MH, Desaiah D, Ossanna MJ, et al. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol. 2008; 23(3): 161–169.
- Gee NS, Brown JP, Dissanayake VU, et al. The novel anticonvulsant drug, gabapentin (Neurontin), binds to the alpha2delta subunit of a calcium channel. J Biol Chem. 1996; 271(10): 5768–5776.
- Verma V, Singh N, Singh Jaggi A. Pregabalin in neuropathic pain: evidences and possible mechanisms. Curr Neuropharmacol. 2014; 12(1): 44–56.
- Smith EM, Pang H, Cirrincione C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013; 309(13): 1359–1367.
- Razazian N, Baziyar M, Moradian N, et al. Evaluation of the efficacy and safety of pregabalin, venlafaxine, and carbamazepine in patients with painful diabetic peripheral neuropathy. A randomized, double-blind trial. Neurosciences (Riyadh). 2014; 19(3): 192–198.
- Boonstra AM, Stewart RE, Köke AJA, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016; 7: 1466.
- Timmerman H, Steegers MAH, Huygen FJ, et al. Investigating the validity of the DN4 in a consecutive population of patients with chronic pain. PLoS One. 2017; 12(11): e0187961.
- Begum S, Poojitha K, Kumar G, et al. A comparative study on efficacy and safety of tablet duloxetine 60 mg and tablet gabapentin 300 mg among patients with diabetic polyneuropathy — a randomized double-blind study. Natl J Physiol Pharm Pharmacol. 2023; 13(1): 177–184.
- Salehifar E, Janbabaei G, Hendouei N, et al. Comparison of the efficacy and safety of pregabalin and duloxetine in taxane-induced sensory neuropathy: a randomized controlled trial. Clin Drug Investig. 2020; 40(3): 249–257.
- Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997; 50(6): 683–691.
- Quilici S, Chancellor J, Löthgren M, et al. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009; 9: 6.
- Rudroju N, Bansal D, Talakokkula ST, et al. Comparative efficacy and safety of six antidepressants and anticonvulsants in painful diabetic neuropathy: a network meta-analysis. Pain Physician. 2013; 16(6): E705–E714.
- Shah I, Ahmad W, Islam M, et al. A prospective observational study comparing the efficacy and safety of duloxetine and pregabalin in diabetic peripheral neuropathic pain. Cureus. 2022; 14(9): e28683.
- Shahid W, Kumar R, Shaikh A, et al. Comparison of the efficacy of duloxetine and pregabalin in pain relief associated with diabetic neuropathy. Cureus. 2019; 11(7): e5293.
- Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114(1–2): 29–36.
- Avan R, Janbabaei G, Hendouei N, et al. The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial. J Res Med Sci. 2018; 23: 52.
- Widyadharma IPE, Rau CPV, Pinzon RT, et al. Efficacy and safety of duloxetine in the treatment of chemotherapy induced peripheral neuropathy: a systematic review and meta-analysis. Malang Neurol J. 2021; 7: 48–55.
