Evidence map›Paper›PMID 37940831›Full record

SynthesisClinical drug investigation2023

Monotherapy Versus Combination Therapy in the Treatment of Painful Diabetic Neuropathy: A Systematic Review and Meta-analysis.

Julyana Medeiros Dantas, Mariana de Jesus Oliveira, Luciana Alves Oliveira Silva, Sávio Batista, Caroline Serafim Dagostin, Daniel Campinho Schachter

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Clinical drug investigation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Diabetic neuropathy: cutting-edge research and future directions.Signal transduction and targeted therapy · 2025
    Review
  6. Article
  7. Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 6 institutions in 2 countries.

Julyana Medeiros DantasDepartment of Clinical Medicine, Universidade Federal do Rio Grande do Norte, Avenida Nilo Peçanha, 620 - Petrópolis, Natal, RN, Brazil. julyana.dantas.114@ufrn.edu.br.ORCID http://orcid.org/0000-0002-0915-0932
Mariana de Jesus OliveiraDepartment of Medicine, Faculdade de Ensino Superior da Amazônia Reunida, Redenção, PA, Brazil.
Luciana Alves Oliveira SilvaDepartment of Vascular Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Sávio BatistaDepartment of Clinical Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Caroline Serafim DagostinDepartment of Medicine, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.
Daniel Campinho SchachterDepartment of Health Sciences, Universidade Unigranrio Afya, Duque de Caxias, RJ, Brazil.
Amazon (United States) · USUniversidade do Extremo Sul Catarinense · BRUniversidade Federal de São Paulo · BRUniversidade Federal do Rio de Janeiro · BRUniversidade Federal do Rio Grande do Norte · BRUniversidade Unigranrio · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivePainful peripheral neuropathy is a common and challenging complication of diabetes mellitus. Combination therapy is used widely by clinicians, although strong evidence for efficacy and safety is lacking. The goal of this study is to compare the efficacy and safety of combination versus monotherapy of first-line medications for peripheral diabetic neuropathy.

methodsPubMed, Embase, Cochrane Central, and clinicaltrials.gov databases were searched on December 5, 2022, for randomized clinical trials comparing combined therapy with gabapentinoids and either tricyclic antidepressants (TCAs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) versus monotherapy with any of these drugs. Pooled mean differences (MD) with a 95% confidence interval (CI) were computed for pain outcomes, measured on an 11-point numeric rating scale averaging pain scores in the last 7 days. Risk ratios (RRs) were computed for binary endpoints. Risk assessment was performed using the Risk of Bias 2 tool.

resultsA total of five randomized studies and 916 patients were included. Follow-up ranged from 6 to 12 weeks. Mean pain reduction was greater for combination therapy than monotherapy (MD - 0.39; 95% CI - 0.67 to - 0.12; p = 0.005). Similarly, there was an improvement in ≥ 30% reduction in average pain (RR 1.16; 95% CI 1.07-1.26; p < 0.01) with combination therapy. In contrast, there was no significant difference between groups in ≥ 50% reduction in average pain (RR 1.21; 95% CI 0.99-1.49; p = 0.06). When comparing combination therapy versus gabapentinoid monotherapy, there was also a significant reduction in average pain (MD - 0.61; 95% CI - 0.85 to - 0.37; p < 0.01) with combination therapy.

conclusionIn patients with painful diabetic peripheral neuropathy, the combination of gabapentinoids with TCAs or SNRIs is associated with a greater reduction in pain as compared with monotherapy, although this difference may not translate into a clinically important difference.

Indexed as

Diabetes MellitusDiabetic NeuropathiesSerotonin and Noradrenaline Reuptake InhibitorsHumansPainPeripheral Nervous System DiseasesRandomized Controlled Trials as TopicSelective Serotonin Reuptake InhibitorsSelective Serotonin Reuptake InhibitorsSerotonin and Noradrenaline Reuptake Inhibitors

Identifiers

PMID37940831
OpenAlexW4388501684

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.