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Duloxetine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN): systematic review and meta-analysis
  1. Ronald Chow1,
  2. Madison Novosel2,
  3. Olivia W So1,
  4. Shreya Bellampalli3,
  5. Jenny Xiang4,
  6. Gabriel Boldt5,
  7. Eric Winquist5,
  8. Michael Lock5,
  9. Maryam Lustberg2 and
  10. Elizabeth Prsic2
  1. 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Yale School of Medicine, Yale University, New Haven, Connecticut, USA
  3. 3Mayo Clinic School of Medicine, Rochester, Minnesota, USA
  4. 4MD Anderson Cancer Center, Houston, Texas, USA
  5. 5Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  1. Correspondence to Dr Elizabeth Prsic, Yale School of Medicine, New Haven, CT 06510, USA; elizabeth.prsic{at}yale.edu

Abstract

Introduction Duloxetine has previously been reported to be promising in the setting of chemotherapy-induced peripheral neuropathy (CIPN). The aim of this study was to conduct a comprehensive systematic review and meta-analysis, on the use of duloxetine in prevention and treatment of CIPN.

Methods PubMed, Embase and Cochrane CENTRAL were searched from database inception up until April 2022. Articles were included in this review if they reported on duloxetine use in the setting of CIPN, in a multiarm comparative human trial. A random effects DerSimonian-Laird model was used to calculate summary risk ratios (RR) and corresponding 95% CIs, comparing duloxetine to placebo. This review was registered on.

Results Seven randomised controlled trials that included 645 patients were identified. Five reported on duloxetine for treatment of CIPN, and two for prevention of CIPN. Two studies had some concern for bias. Duloxetine was statistically similar to placebo in its efficacy, both in the treatment (RR 0.92, 95% CI 0.84 to 1.01) and prevention (RR 1.02, 95% CI 0.87 to 1.19) of CIPN. Safety profile was similar, in the treatment (RR 1.31, 95% CI 0.90 to 1.89) and prevention (RR 1.52, 95% CI 0.98 to 2.38) setting.

Conclusion There is currently limited evidence supporting duloxetine’s use for CIPN. There is a need for more comprehensive and higher-quality trials assessing duloxetine in the setting of CIPN, before further clinical practice recommendations.

Trial registration number PROSPERO (CRD42022327487).

  • Symptoms and symptom management
  • Supportive care

Data availability statement

No data are available.

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Data availability statement

No data are available.

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Footnotes

  • Twitter @ElizabethPrsic

  • Contributors All authors contributed significantly, and are accountable for the published work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.