Effectiveness of duloxetine in treatment of painful chemotherapy-induced peripheral neuropathy: a systematic review
Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect that can be dose limiting and affect patient quality of life. To date, the therapeutic options for CIPN are limited. We performed a systematic literature search of the PubMed and Scopus databases to assess the effectiveness of duloxetine in the treatment of pain in patients with CIPN. The search included randomized controlled trials, nonrandomized controlled trials, retrospective studies, and single-arm studies of duloxetine in treatment of CIPN. A descriptive analysis of the studies was performed. The PubMed database online search identified 41 publications, and a second database search through Scopus identified 29 publications. A total of 10 full-text articles were assessed for eligibility, with 5 articles excluded. Altogether, the included studies reported 431 patients with painful CIPN. An improvement in pain scores was the primary and/or secondary endpoint in the included studies. Pain was assessed by 6 different scores. Comparator drugs were used in 4 studies in our review. The comparator drug was placebo in 1 study only, and the remaining 3 studies used other antineurotoxicity therapy. The chemotherapeutic agents used in the studies were the following: paclitaxel (52.9%), oxaliplatin (39.7%), R-CHOP (rituximab, doxorubicin, vincristine, and cyclophosphamide; 3.30%), combined bortezomib-dexamethasone (1.89%), FOLFOX (folinic acid, fluorouracil, and oxaliplatin; 1.18%), and other taxanes (0.94%). From the descriptive analyses, and from the available data of relatively small sample sized studies, it can be concluded that despite the above limitations, duloxetine remains a useful therapeutic option for pain in CIPN patients, regardless of the type of chemotherapeutic agent used.
Accepted for publication November 20, 2018
Correspondence Wael Ibrahim, MD; dr.wael_ezzat@hotmail.com
Disclosures The authors report no disclosures/conflicts of interest.
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0436
Strength and limitations
The first strength of this review is that it identifies gaps in our current knowledge about duloxetine in the treatment of pain in cancer patients with CIPN. Second, we collected all available articles from inception until January 2018. Third, this review can serve as a model for future studies investigating the effectiveness of duloxetine in treatment of CIPN.
There are also limitations to this review that should be discussed. First, the studies vary greatly in samples, methodologies, and outcomes measured. Second, the diagnostic criteria for CIPN and the pain assessment tools vary among the studies. Third, there is also variability in the duloxetine doses and administration regimens among the studies, and some articles did not report the precise outcome in pain scores. Furthermore, the articles reviewed included retrospective, single-arm, or nonrandomized controlled studies with relatively small numbers of participants.
To improve the results, more placebo-controlled or head-to-head trials (with other agents used in treatment of CIPN) with large sample sizes would be needed.
Conclusions
Our purpose was to describe the effectiveness of duloxetine in improving pain scores among CIPN patients
Acknowledgments
That authors express their sincere gratitude to Nahla A Merghany and Sarah M Abd Elfadel for helping them retrieve all the relevant articles for this review.
