Behandelcentrum Neuropathische Pijn

Home

Duloxetine: resultaten meta-analyse in diabetische pijn

Engelse neurologen beschreven in 2008 een meta-analyse van de werkzaamheid van de serotonine opname remmer Duloxetine hydrochloride, een stof die veel verwantschap heeft met fluoxetine. Er werden drie studies in diabetische pijnlijke neuropathie gevonden, en hun uiteindelijke conclusie was:

overall 41% of patients achieved 50% pain relief with any dose of duloxetine compared with 24% with placebo. ^[1]

Duloxetine: Numbers needed to treat: 5.9

Combining all doses in both conditions (2,216 patients), the NNT for one patient to achieve at least 50% pain relief with duloxetine compared with placebo was 5.9 (95% CI 4.8 to 7.7).

De eindmeting was in alle gevallen hetzelfde, tenminste 50% pijnreductie: at least 50% pain relief over baseline in the 24-hour average pain score by the end of the trial.

Duloxetine: Numbers needed to harm: 15

Welke dosis de patienten kregen, dat maakte op de effectiviteit niets uit. 60 mg was dus even goed als 120 mg, alleen 60 mg werd uiteraard beter verdragen. Wat betreft de bijwerkingen, uitgedrukt in NNH het volgende werd gevonden:

Withdrawals due to adverse events occurred significantly more often with duloxetine (15%) than placebo (8%). The NNH was 15 (11 to 25) (Table 1). They were 2% to 8% lower with 60 mg than 120 mg, giving an NNH of 19 (11 to 86) for 120 mg compared to 60 mg.

Duloxetine: Misselijkheid, slaperigheid, verstoppingen en afgenomen eetlust

De meest voorkomende bijwerkingen waren misselijkheid, slaperigheid, verstoppingen en afgenomen eetlust

There were statistically significant increases in nausea (29% vs 10%), somnolence (14% vs 4%), constipation (13% vs 3%) and decreased appetite (7% vs 1%) with all doses of duloxetine compared with placebo.

Duloxetine: effectiviteit vergeleken met andere antidepressiva

Dat is goed te zien in de onderstaande tabel:

Summary of efficacy in antidepressant meta-analysis

		Number of		Percent with

Antidepressant	Outcome	Trials	Patients	Placebo	Active	Relative benefit (95% CI)	NNT (95% CI)
Duloxetine 60/120 mg	at least 50% pain relief	3	1,024	27	47	1.7 (1.4 to 2.1)	5.1 (3.9 to 7.3)
Amitriptyline all doses	global improvement	10	588	32	64	2.0 (1.6 to 2.4)	3.2 (2.6 to 4.2)
Other antidepressants	global improvement	3	216	12	50	4.2 (2.5 to 7.0)	2.6 (2.0 to 3.7)
Venlafaxine all doses	global improvement	3	200	25	57	2.3 (1.6 to 3.4)	3.1 (2.2 to 5.1)
Desipramine all doses	global improvement	2	78	10	59	5.8 (2.2 to 15)	2.1 (1.5 to 3.3)
Imipramine all doses	global improvement	2	58	5	97	19 (3.9 to 89)	1.1 (1.0 to 1.2)

NNT – Number need to treat

Cochrane analyse 2009 gaf als samenvatting:

Duloxetine at 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short-term to 12 weeks with a risk ratio (RR) for 50% pain reduction at 12 weeks of 1.65 (95% confidence interval (CI) 1.34 to 2.03), number needed to treat (NNT) 6 (95% CI 5 to 10). ^[2]

Maart 2010, prof. dr. Jan M. Keppel Hesselink

Referenties

[1]: Sultan A, Gaskell H, Derry S, Moore RA. | Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials. | BMC Neurol. | 2008 Aug 1;8:29.

[2]: Lunn MP, Hughes RA, Wiffen PJ. | Duloxetine for treating painful neuropathy or chronic pain. | Cochrane Database Syst Rev. | 2009 Oct 7;(4):CD007115.