Pathogenetic treatments for diabetic peripheral neuropathy

Area of Science:

• Neurology
• Endocrinology
• Pharmacology

Background:

• Diabetic peripheral neuropathy (DPN) affects approximately one-third of individuals with diabetes.
• Current DPN management includes lifestyle changes, intensive glycemic control, cardiovascular risk intervention, pathogenesis-oriented pharmacotherapy, and symptomatic pain relief.
• Symptomatic analgesic monotherapy offers limited efficacy and potential adverse events, highlighting an unmet need for novel DPN treatments.

Purpose of the Study:

• To review current and emerging therapeutic strategies for diabetic peripheral neuropathy (DPN).
• To evaluate the potential of pathogenetic approaches in preventing or improving DPN.
• To assess the clinical efficacy and safety of specific agents in DPN management.

Main Methods:

• Review of preclinical studies and clinical trials investigating DPN treatments.
• Analysis of meta-analyses and randomized clinical trials (RCTs) for agents like alpha-lipoic acid, benfotiamine, actovegin, and epalrestat.
• Examination of findings from pivotal trials such as NATHAN 1 for asymptomatic DPN.

Main Results:

• Preclinical data suggest agents interfering with DPN pathophysiology can prevent or improve the condition.
• Meta-analyses and RCTs show efficacy and safety for alpha-lipoic acid, benfotiamine, actovegin, and epalrestat in symptomatic DPN.
• The NATHAN 1 trial indicated improvement in neuropathic signs in asymptomatic DPN after four years of treatment.

Conclusions:

• Several compounds demonstrate efficacy and safety for symptomatic DPN treatment.
• These agents, authorized in various countries, show promise for DPN management.
• Further long-term clinical trials are needed to establish their value as monotherapies and combination therapies for DPN.