Duloxetine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN): systematic review and meta-analysis

Chow, Ronald; Novosel, Madison; So, Olivia W; Bellampalli, Shreya S.; Xiang, Jenny; Boldt, Gabriel; Winquist, Eric; Lock, Michael; Lustberg, Maryam B.; Prsic, Elizabeth Horn

doi:10.1136/spcare-2022-003815

Cited by 16 publications

(9 citation statements)

References 25 publications

(53 reference statements)

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“…The literature search in PubMed was restricted to articles published in peer-reviewed journals and written in English. In addition to the systematic literature search, we evaluated studies manually obtained primarily by reviewing previously reported clinical guidelines and systematic reviews ( 10 , 11 , 13 , 17 , 25 ). Two authors independently screened each study for eligibility, and disagreements among reviewers were resolved through discussion.…”

Section: Methodsmentioning

confidence: 99%

“…They note that duloxetine is the only medication with sufficient evidence supporting its use in CIPN patients experiencing established pain ( 9 , 10 ). Recent studies suggest that its effectiveness is comparable to that of a placebo ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…Although exercise therapy for CIPN mitigation has not been established as part of any established guideline, several systematic reviews imply the potential efficacy of exercise for the prevention and treatment of symptoms related to CIPN ( 10 , 11 , 13 , 17–19 ). In these studies, the dose, frequency, intensity, and duration of exercise programs varied (i.e., ranging from inactivity avoidance instructions to resistance training), and the outcome (e.g., specific sensorimotor functions, activities of daily living, QOL) also varied across the studies.…”

Section: Introductionmentioning

confidence: 99%

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Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis

Nakagawa,

Yamamoto,

Hanai

et al. 2024

Front. Neurol.

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PurposeAlthough exercise is recommended for cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN), the effective types of exercise for preventing and treating CIPN remain unclear. This systematic review and network meta-analysis (NMA) aimed to evaluate the comparative effects of exercise on CIPN.MethodsWe included relevant randomized controlled trials (RCTs) identified in a 2019 systematic review that evaluated the effects of exercise on CIPN and conducted an additional search for RCTs published until 2023. We evaluated the risk of bias for each RCT; the comparative effectiveness of exercise on patient-reported quality of life (QOL) through an NMA; and the effectiveness of exercise on QOL scores, patient-reported CIPN symptoms, and pain through additional meta-analyses.ResultsTwelve studies (exercise, n = 540; control, n = 527) comparing 8 exercise interventions were included in the analysis. All studies were determined to have a high risk of bias. The meta-analyses showed significantly improved QOL [standard mean differences (SMD) 0.45; 95% confidence interval (CI) = 0.12 to 0.78] and CIPN symptoms (SMD 0.46; 95% CI = 0.11 to 0.82). No severe adverse events were reported. Pain tended to improve with exercise (SMD 0.84; 95% CI = −0.11 to 1.80). An NMA suggested that the interventions of a combination of balance and strength training showed a significant improvement in QOL scores compared to the control.ConclusionExercise interventions may be beneficial for improving QOL and CIPN symptoms. High-quality large clinical trials and data are needed to conclude that exercise is beneficial and safe.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis

Nakagawa,

Yamamoto,

Hanai

et al. 2024

Front. Neurol.

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“…[2][3][4] However, a recent meta-analysis shows that duloxetine's efficacy in treating CIPN is not considerably more remarkable than the placebo effect, and caution should be used concerning its side effects. 10,11 Based on the above discussion, the search for a proven treatment is critical.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Neuromodulation Interventions for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Xu,

Yu,

Zhang

et al. 2024

JPR

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To determine the efficacy and safety of a neuromodulation intervention regimen in the treatment of chemotherapy-induced peripheral neuropathy (CIPN). Patients and Methods: Systematic searches were conducted in seven English databases. Randomized controlled trials of all neuromodulation interventions (both invasive and non-invasive) for the treatment of CIPN were selected. Group comparisons of differences between interventions and controls were also made. We divided the outcomes into immediate-term effect (≤3 weeks), short-term effect (3 weeks to ≤3 months), and long-term effect (>3 months). Results: Sixteen studies and 946 patients with CIPN were included. Among immediate-term effects, neuromodulation interventions were superior to usual care for improving pain (SMD=−0.77, 95% CI −1.07~ 0.47), FACT-Ntx (MD = 5.35, 95% CI 2.84~ 7.87), and QOL (SMD = 0.44, 95% CI 0.09~ 0.79) (moderate certainty); neuromodulation loaded with usual care was superior to usual care for improving pain (SMD=−0.47, 95% CI −0.71 ~ −0.23), and QOL (SMD = 0.40, 95% CI 0.12 ~ 0.69) (moderate certainty). There were no statistically significant differences between the neuromodulation interventions regimen vs usual care in short-and long-term outcomes and neuromodulation vs sham stimulation from any outcome measure. There were mild adverse events such as pain at the site of stimulation and bruising, and no serious adverse events were reported. Conclusion: Neuromodulation interventions had significant immediate-term efficacy in CIPN but had not been shown to be superior to sham stimulation; short-term and long-term efficacy could not be determined because there were too few original RCTs. Moreover, there are no serious adverse effects of this therapy.

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“…CIPN is one of the most frequent dose-limiting side effects of chemotherapy 2 4. Although numerous clinical trials have been conducted to prevent or treat CIPN using various targeted drugs, previous systematic reviews with direct comparisons have failed to demonstrate the efficacy of drug therapy in the prevention or treatment of CIPN 36–38. No systematic reviews of CIPN have indirectly compared the available pharmacological options for its prevention and treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of drug therapy for the prevention and treatment of chemotherapy-induced peripheral neuropathy: a protocol for a systematic review and network meta-analysis

Sato,

Hasegawa,

Noma

et al. 2023

BMJ Open

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IntroductionChemotherapy-induced peripheral neuropathy (CIPN) is one of the most common dose-limiting side effects of chemotherapeutic drugs. Numerous clinical trials of various targeted drugs for the prevention or treatment of CIPN have been conducted; however, previous systematic reviews with direct comparisons have failed to demonstrate the efficacy of these drugs in the prevention or treatment of CIPN. In addition, no systematic reviews have indirectly compared CIPN prevention and treatment. This article describes a protocol for evaluating the efficacy and safety of drug therapy for the prevention and treatment of CIPN. The results of the proposed systematic review with network meta-analysis (NMA) will provide new insights into the prevention and treatment of CIPN.Methods and analysisWe will conduct a literature search in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov to find relevant articles published through January 2023. We will include studies that investigated the efficacy and safety of vitamin B12, goshajinkigan, non-steroidal anti-inflammatory analgesics, opioids, calcium and magnesium, antidepressants and anticonvulsants on CIPN. Two authors will individually screen the retrieved reports and review the full text based on the selection criteria. The primary outcome is the incidence and severity of CIPN. The risk of bias will be assessed using V.2.0 of the Cochrane risk-of-bias tool. We will apply a frequentist random-effects NMA model to pool effect sizes across trials using risk ratios and mean differences with their 95% CIs. Competing interventions will be ranked using the surface under cumulative ranking probabilities. Heterogeneity will be assessed using the heterogeneity variance τ2, Cochran’s Q test and I² statistic.Ethics and disseminationThis review does not require ethical approval. The research will be published in a peer-reviewed journal.PROSPERO registration numberCRD42022371829.

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Duloxetine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN): systematic review and meta-analysis

Cited by 16 publications

References 25 publications

Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis

Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis

The Efficacy of Neuromodulation Interventions for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Efficacy and safety of drug therapy for the prevention and treatment of chemotherapy-induced peripheral neuropathy: a protocol for a systematic review and network meta-analysis

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