Long-Term Clinical Effects of Epalrestat, an Aldose Reductase Inhibitor, on Diabetic Peripheral Neuropathy: The 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial

• Published in: Diabetes care Vol. 29; no. 7; pp. 1538 - 1544
• Main Authors: Hotta, Nigishi, Akanuma, Yasuo, Kawamori, Ryuzo, Matsuoka, Kempei, Oka, Yoshitomo, Shichiri, Motoaki, Toyota, Takayoshi, Nakashima, Mitsuyoshi, Yoshimura, Isao, Sakamoto, Nobuo, Shigeta, Yukio
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2006
• Subjects: Adult; adverse effects; Aged; aldehyde reductase; Aldehyde Reductase - antagonists & inhibitors; analogs & derivatives; antagonists & inhibitors; Biological and medical sciences; Blood Glucose; Blood Glucose - metabolism; Care and treatment; Clinical trials; Comparative analysis; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies; Diabetic Angiopathies - physiopathology; Diabetic Neuropathies; Diabetic Neuropathies - drug therapy; Diabetic neuropathy; Diabetic retinopathy; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enzyme Inhibitors; Enzyme Inhibitors - therapeutic use; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General and cellular metabolism. Vitamins; Glycated Hemoglobin; Glycated Hemoglobin A - metabolism; glycemic control; Humans; Inhibitor drugs; Male; Medical sciences; Metabolic disorders; metabolism; microangiopathy; Middle Aged; nerve tissue; Neural Conduction; Neural Conduction - physiology; Patients; Pharmacology. Drug treatments; physiology; physiopathology; Rhodanine; Rhodanine - adverse effects; Rhodanine - analogs & derivatives; Rhodanine - therapeutic use; Risk factors; Statistical methods; therapeutic use; Thiazolidines; vibration; United States; Endocrinopathy; Human; Epalrestat; Nervous system diseases; Enzyme; Diabetes mellitus; Multicenter study; Enzyme inhibitor; Peripheral neuropathy; Long term; Aldehyde reductase; Complication; Clinical trial; Peripheral nerve disease; Oxidoreductases; Comparative study
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc05-2370

OBJECTIVE:--We sought to evaluate the long-term efficacy and safety of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS--Subjects with diabetic neuropathy, median motor nerve conduction velocity (MNCV) >=40 m/s, and HbA₁c <=9% were enrolled in this open-label, multicenter study and randomized to 150 mg/day epalrestat or a control group. After excluding the withdrawals, 289 (epalrestat group) and 305 (control group) patients were included in the analyses. The primary end point was change from baseline in median MNCV at 3 years. Secondary end points included assessment of other somatic nerve function parameters (minimum F-wave latency [MFWL] of the median motor nerve and vibration perception threshold [VPT]), cardiovascular autonomic nerve function, and subjective symptoms. RESULTS:--Over the 3-year period, epalrestat prevented the deterioration of median MNCV, MFWL, and VPT seen in the control group. The between-group difference in change from baseline in median MNCV was 1.6 m/s (P < 0.001). Although a benefit with epalrestat was observed in cardiovascular autonomic nerve function variables, this did not reach statistical significance compared with the control group. Numbness of limbs, sensory abnormality, and cramping improved significantly with epalrestat versus the control group. The effects of epalrestat on median MNCV were most evident in subjects with better glycemic control and with no or mild microangiopathies. CONCLUSIONS:--Long-term treatment with epalrestat is well tolerated and can effectively delay the progression of diabetic neuropathy and ameliorate the associated symptoms of the disease, particularly in subjects with good glycemic control and limited microangiopathy.