Disease-modifying therapies for diabetic peripheral neuropathy: A systematic review and meta-analysis of randomized controlled trials

• Published in: Journal of diabetes and its complications Vol. 38; no. 2; p. 108691
• Main Authors: Ran, Gui-Lin, Li, Yan-Ping, Lu, Li-Chin, Lan, Shao-Huan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2024; Elsevier Limited
• Subjects: Acids; Alpha-lipoic acid; Bias; Clinical trials; Diabetes; Diabetic Neuropathies - drug therapy; Diabetic neuropathy; Diabetic peripheral neuropathy; Drug Therapy, Combination; Drugs; Epalrestat; Humans; Mecobalamin; Meta-analysis; Neural Conduction - drug effects; Neural Conduction - physiology; Peripheral neuropathy; Randomized Controlled Trials as Topic; Regulatory approval; Rhodanine - administration & dosage; Rhodanine - analogs & derivatives; Rhodanine - therapeutic use; Systematic review; Thiazolidines; Thioctic Acid - administration & dosage; Thioctic Acid - therapeutic use; Treatment Outcome; Vitamin B 12 - administration & dosage; Vitamin B 12 - analogs & derivatives; Vitamin B 12 - therapeutic use; China; Epalrestat; Diabetic peripheral neuropathy; Alpha-lipoic acid; Mecobalamin; Meta-analysis
• DOI: 10.1016/j.jdiacomp.2024.108691
• ISSN: 1056-8727; 1873-460X

Alpha-lipoic acid, epalrestat, and mecobalamin are widely used as monotherapies for diabetic peripheral neuropathy. However, whether a triple-combination therapy with these three drugs is superior to monotherapy or dual therapy remains debatable. Nine randomized controlled trials were identified through a search on electronic databases such as PubMed, Web of Science, and Cochrane Library. The trial participants (N = 1153) were divided into the experimental group who received the triple-combination therapy and the control group who received conventional or dual therapy with the aforementioned drugs. Therapeutic outcomes were better in the experimental group than in the control group (odds ratio: 3.74; 95 % confidence interval: 2.57–5.45; I2 = 0 %; p < 0.00001). No statistic difference was noted in adverse effects. Compared with the control group, the experimental group exhibited significant improvements in median motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and vibration perception thresholds (VPT) in the left and right lower limbs. In the control group, a subgroup analysis by treatment strategy revealed similar improvements in total efficacy, MNCV, and SNCV. For diabetic peripheral neuropathy, the triple-combination therapy may be more effective than monotherapy or dual therapy. •DPN is the most common complication of DM.•ALA + MC + epalrestat might be an effective and safety treatment procedure.