Credits Earned (2024) Crédits obtenus

Redeem Prepaid Membership

Tools for Practice Outils pour la pratique


#103 Duloxetine (Cymbalta®): Jack of All Trades, Master of None?


CLINICAL QUESTION
QUESTION CLINIQUE
How safe and effective is duloxetine for the treatment of chronic painful conditions?


BOTTOM LINE
RÉSULTAT FINAL
Compared to placebo, duloxetine appears efficacious in neuropathic pain, improving pain by 50% or more for one in seven people. One in 20 people (over placebo) will have to quit due to adverse events. 



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
Compared to placebo: Meta-analysis1 of five randomized controlled trials (RCTs) with 2,589 diabetic peripheral neuropathy patients over ≤12 weeks. 
  • ≥50% improvement in painduloxetine 46% vs. placebo 30% (Number Needed to Treat (NNT)=7). 
    • Mean pain scores improved by ~0.95 more with duloxetine than placebo (on 0–10 scale). 
  • Adverse events leading to discontinuation: Duloxetine 60 mg/day 12.6% vs. placebo 5.8% (Number Needed to Harm (NNH)=20). 
    • Adverse events included nausea (NNH=7), somnolence (NNH=14), dry mouth (NNH=14), and dizziness (NNH=22). 
  • Increasing dose no advantage: no difference in response but more adverse events. 
  • Similar results in one other RCT2 and several meta-analyses.3-5
Compared to other neuropathic pain medications: 
  • RCT6 of 804 diabetic peripheral neuropathy patients treated with either duloxetine 60 mg/day or pregabalin 300 mg/day for eight weeks.    
    • ≥50% improvement in pain: Duloxetine 40% vs. pregabalin 28% (NNT=9). 
    • ~12% discontinued treatment due to adverse effects in both groups. 
    • Trial sponsored by manufacturer of Cymbalta®. 
  • Previous small trials showed no conclusive difference between duloxetine and amitriptyline7,8 or pregabalin8,9 in neuropathic pain. 

CONTEXT
CONTEXTE
  • Duloxetine is also efficacious in other chronic painful conditions, including fibromyalgia1 (NNT=8)chemotherapy-induced neuropathic pain (NNT ~9),10 and osteoarthritis of the knee (NNT=68).11,12  
  • For depression, duloxetine has similar efficacy and overall safety to other second generation antidepressants, with no clear advantages compared to other agents.13 
  • Duloxetine trials are at moderate-to-high risk of bias: industry funding, short duration, high risk of selective outcome reporting, high drop-out rates, multiple outcomes without adjustment and possible selective publication.     
 


Latest Tools for Practice
Derniers outils pour la pratique

#379 Bumpin’ Up the Protection? RSV Vaccine in Pregnancy

How effective and safe is the respiratory syncytial virus (RSV) vaccine (AbrysvoTM) when given during pregnancy?
Read Lire 0.25 credits available Crédits disponibles

#378 Tony Romo-sozumab: Winning touchdown in osteoporosis or interception for the loss?

What is the efficacy and safety of romosozumab in postmenopausal women with osteoporosis?
Read Lire 0.25 credits available Crédits disponibles

#377 How to slow the flow IV: Combined oral contraceptives

In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • G. Michael Allan MD CCFP
  • Ricky D. Turgeon BSc(Pharm) ACPR PharmD

1. Lunn MP, Highes RA, Wiffen PJ. Cochrane Database Syst Rev. 2009; (4):CD007115.

2. Gao Y, Guo X, Han P, et al. Int J Clin Pract. 2015; 69:957-66.

3. Griebeler ML, Morey-Vargas OL, Brito JP, et al. Ann Intern Med. 2014; 161:639-49.

4. Finnerup NB, Attal N, Haroutounian S, et al. Lancet Neurol. 2015; 14:162-73.

5. Waldfogel JM, Amato Nesbit S, Dy SM, et al. Neurology. 2017; 88:1958-67.

6. Tesfaye S, Wilhelm S, Lledo A, et al. Pain. 2013; 154(12):2616–25.

7. Kaur H, Hota D, Bhansali A, et al. Diabetes Care. 2011; 34:818–22.

8. Boyle J, Eriksson ME, Gribble L, et al. Diabetes Care. 2012; 35:2451–8.

9. Tanenberg RJ, Irving GA, Risser RC, et al. Mayo Clin Proc. 2011; 86:615–24.

10. Lavoie Smith EM, Pang H, Cirrincione C, et al. JAMA. 2013; 309:1359–67.

11. Frakes EP, Risser RC, Ball TD, et al. Curr Med Res Opin. 2011; 27:2361–72.

12. Hochberg MC, Wohlreich M, Gaynor P, et al. J Rheumatol. 2012; 39:352–8.

13. Cipriani A, Koesters M, Furukawa TA, et al. Cochrane Database Syst Rev. 2012; (10):CD006533.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Most recent review: 27/01/2018

By: RIcky D Turgeon BSc(Pharm) ACPR PharmD, G Michael Allan MD CCFP

Comments:

Evidence reviewed: January 27, 2018. Evidence update: New RCTs. Bottom line: Numbers changed, conclusion the same.

Learning at a glance
Yearly credits
Acquired ()
Your content by topic
Cardiology Dermatology Emergency
My Bookmarks