Suboptimal Treatment of Diabetic Peripheral Neuropathic Pain in the United States

Objective: Approximately one third of patients with diabetic peripheral neuropathy (DPN) also experience neuropathic pain, resulting in a significant health care burden, and reduced quality of life. Pregabalin, duloxetine, and tapentadol extended-release are approved for treating diabetic peripheral neuropathic pain (DPNP), but many other medications are commonly used "off-label" with various degrees of success. We examined US health insurance claims to determine the current DPNP treatment patterns.

Methods: This retrospective analysis used the MarketScan claims database to identify adults with continuous health plan enrollment for 12 months pre- and postindex who were initially diagnosed with DPN between 2006 and 2011 and were provided a prescription for a medication reported to be beneficial for treating DPNP (anticonvulsants, antidepressants, opioids, or topical agents). We evaluated the frequency and types of medication dispensed within 1 year after first diagnosis, treatment adherence, and patterns of treatment alteration.

Results: Overall, 12,074 patients met inclusion criteria, with 66.6% initiating an anticonvulsant (gabapentin 45.0%; pregabalin 21.6%), and 5.2% initiating duloxetine. Patients commonly received less than the recommended dose of prescribed medication, and adherence was suboptimal for all treatments. It is estimated that up to 50% of patients discontinued their initial treatment within 3 months of initiation.

Conclusions: Newly diagnosed patients with DPNP are most commonly prescribed anticonvulsants. Many patients receive lower than recommended dosages, potentially resulting in poor outcomes. Initial treatments are frequently discontinued, indicating low levels of satisfaction and/or poor tolerability. New therapies with improved efficacy and better tolerability are urgently needed for DPNP.