Hussain Ahmad1, K. M. Hafizur Rahman2, Miftaul Jannat Chowdhury3, Samir Uddin4,
Sadiqur Rahman5, Abu Tareq Md. Rashel6
Sadiqur Rahman5, Abu Tareq Md. Rashel6
1. Associate Professor, Dept. of Pharmacology and Therapeutics, Sylhet Women’s Medical College, Sylhet
2. Senior Lecturer, Dept. of Pharmacology and Therapeutics, Sylhet Women’s Medical College, Sylhet
3. Associate Professor, Dept. of Pharmacology and Therapeutics, Sylhet Women’s Medical College, Sylhet
4. Professor, Dept. of Anatomy, Parkview Medical College, Sylhet
5. Assistant Professor, Dept. of Medicine, Parkview Medical College, Sylhet
6. Assistant Professor, Dept. of Pharmacology and Therapeutics, Sylhet Women’s Medical College, Sylhet
Abstract
Diabetic peripheral neuropathy (DPNP) is commonly found in prolonged uncontrolled diabetic patients. As the pathophysiology is not completely understood yet, symptoms relief is the core of therapy. Gabapentine and Duloxetine are being using worldwide for DPNP Neurotropic vitamins (vitamin B1. B6 and B12) are also being using as first line agent. But clinical data are not sufficient to draw an effective conclusion. This prospective comparative clinical study conducted in Department of Pharmacology and Therapeutics, Sylhet Women’s Medical College, Sylhet, Bangladesh from July 2018 to June 2019. Diagnosis of DPNP confirmed by Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathic en-4 (DN4). Patients were treated by Gabapentine (Group-A) and Duloxetine (Group-B), and followed up at 4th, 8th and 12th week of treatment using 11-point numerical pain rating scale (NRS) and clinical global impression of change (CGIC) score. A total of 74 patients with DPNP were recruited Final comparison was done in 64 patients – 32 in Group-A and 32 in Group-B. Changes in NRS (p <0.001) and CGIC (p <0.001) were statistically significant during the course of treatment. However, inter-group variation of NRS and CGIC were not statistically significant at the beginning and 4th, 8th and 12th week of treatment. At the end of the treatment, significantly (p = 0.0311) more of Group-A patients (14) than of the Group-B patients (6) reported subjective relief of DPNP in this study Insignificant adverse effects were noted between the groups in this study except constipation (p=0.022) and nausea-vomiting (p = 0.01) of Duloxetine taking group. Gabapentine and Duloxetine are already being using to reduce subjective feeling of pain in DPNP patients. Addition of neurotropic vitamins (vitamin B1, B6 and B12) further improve the treatment outcome in treating DPNP. However, Gabapentine in combination with neurotropic vitamins showed significant promising result compared to Duloxetine with neurotropic vitamins in this study.
Key Words: Gabapentine. Duloxetine, Neurotropic vitamins, Efficacy, Safety.