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Fitzgerald Health Education Associates, Inc., December 2014 fhea.com
Less Expensive Meds as Effective as
Costly Ones in Diabetic Neuropathy,
Rheumatoid Arthritis
P
atients with diabetic neuropathy and rheuma-
toid arthritis (RA) can get as much pain relief
from older, less expensive generic medications
as they can from more expensive medications that
are often prescribed to them, according to several
new studies. The savings can potentially amount to
thousands of dollars per year for each patient.
Diabetic Neuropathy
In the first study, pub-
lished in the Annals
of Internal Medicine
(2014;161:639-649), re-
searchers led by Marcio
L. Griebeler, MD, of the
Mayo Clinic analyzed
data from 65 random-
ized, controlled clinical
trials evaluating different oral and topical analgesics
for diabetic neuropathy. The investigators found no
major differences in how well the medications re-
lieved pain, but some cost 10 times as much as oth-
ers. The trials involved 12,632 patients and were
conducted between January 2007 and April 2014;
the trial data were extracted from multiple electron-
ic databases without language restriction.
In the 9 head-to-head studies reported, greater
pain reduction was associated with serotonin-norep-
inephrine reuptake inhibitors (SNRIs) than with anti-
convulsants and with tricyclic antidepressants (TCAs)
than with topical capsaicin. Meta-analysis showed
that SNRIs, topical capsaicin, TCAs, and anticonvul-
sants were better than placebo for short-term pain
control. Carbamazepine, venlafaxine, duloxetine, and
amitriptyline were more effective than placebo.
Adverse events included somnolence and dizzi-
ness with TCAs, SNRIs, and anticonvulsants; xerosto-
mia with TCAs; and peripheral edema and burning
sensations with pregabalin and capsaicin.
Pregabalin and duloxetine are two of the most
commonly prescribed drugs for diabetic neuropathy.
National drugstore databases show the monthly
costs of these two drugs are approximately $190 and
$171, respectively. However, gabapentin ($19/month),
amitriptyline ($13/month), and nortriptyline ($20/month)
are far less expensive. The nonprescription topical
cream capsaicin costs approximately $14/month.
The study can be accessed
here .
In a commentary accompanying the study, Brian
Callaghan, MD, of the University of Michigan Medical
School, noted that the drugs work about the same, but
what's different are the side effects and costs of the
drugs. The newer drugs cost patients approximately
$200 per month, whereas the older medications run
about $15 to $20 per month. Dr. Callaghan asked why
practitioners should start patients on the expensive
drugs given the similar effects of the medications, and
suggested that it should first be determined whether
or not they respond to the less expensive ones.
Rheumatoid Arthritis
Results of a study published online in the Annals of
the Rheumatic Diseases (October 30, 2014) concluded
that a combination of older generic medications
treated RA in its early stages as effectively as more
intensive treatment, but with less medication, fewer
Prescribing News