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Duloxetine reduces chemotherapy induced peripheral neuropathy

BMJ 2013; 346 doi: (Published 10 April 2013) Cite this as: BMJ 2013;346:f2199

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The antidepressant duloxetine is the first drug shown to reduce pain in people with peripheral neuropathy after chemotherapy with taxanes or platinums. All participants in a placebo controlled crossover trial had moderate to severe pain for at least three months after chemotherapy, mostly paclitaxel or oxaliplatin. Of the 231 patients, 115 were randomised to duloxetine first and 116 to placebo first. The drug was given at 30 mg per day for a week, then 60 mg daily for a month.

After five weeks, the duloxetine group reported an average 10% lower pain score compared with baseline, just above the minimal clinically significant difference, whereas the placebo group reported a 3.4% lower score. Any decrease in pain was reported by 59% versus 38% of people taking duloxetine or placebo, respectively. A 30% pain reduction was twice as common with duloxetine and 50% pain reduction 2.4-fold more common with duloxetine than with placebo. The results also suggest that duloxetine is more effective in people treated with platinums rather than taxanes.

Favourable effects of duloxetine were also seen on secondary outcomes: pain interfering with daily functioning, quality of life, numbness and tingling in the feet, and use of analgesics.

More people in the duloxetine first group dropped out because of adverse events (11% v 1% after the first five weeks), but no serious adverse effects (grade 4 or 5) were seen. Most common with duloxetine were fatigue (7%), insomnia (5%), and nausea (5%).


Cite this as: BMJ 2012;346:f2199

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