Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy

• Published in: Journal of pain & palliative care pharmacotherapy 2016-07, Vol.30 (3), p.184-194
• Main Authors: Kuo, Kuan-Ling, Brixner, Diana, Lipman, Arthur G., Goodman, Michael, Hung, Man, Oderda, Gary M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Analgesics - administration & dosage; Analgesics - economics; Analgesics - therapeutic use; Cohort Studies; combination therapy; Comorbidity; costs; diabetic; Diabetic Neuropathies - drug therapy; Diabetic Neuropathies - economics; Drug Therapy, Combination; Female; Health Care Costs; Humans; Logistic Models; Male; Middle Aged; monotherapy; neuropathy; outcomes; painful; patient characteristics; pharmacotherapy; Proportional Hazards Models; Retrospective Studies; Young Adult
• ISSN: 1536-0288; 1536-0539
• DOI: 10.1080/15360288.2016.1210713

This study compared patient characteristics and health care costs between newly treated diabetic painful neuropathy (DPN) patients receiving mono- pharmacotherapy and those receiving combination pharmacotherapy. A retrospective cohort was developed through Inovalon's Medical Outcomes Research for Effectiveness and Economics Registry (MORE2) database. Patients included were ≥18 years on the date of first DPN prescription: tricyclic antidepressant, opioids, duloxetine, gabapentin, pregabalin, or lidocaine. The authors conducted a simple proportional hazards model comparing times to discontinuation, switch, or addon. Multiple logistic regression was used to identify predictors of combination pharmacotherapy. There were 7145 patients on mono-pharmacotherapy and 421 patients on combination pharmacotherapy. Patients receiving combination pharmacotherapy were 130% more likely to discontinue their medications than patients receiving mono-pharmacotherapy. Female patients and those with > 7 comorbidities were more likely to be started with combination pharmacotherapy. Elderly patients were less likely to be started with combination pharmacotherapy. The total cost of care difference between mono- and combination pharmacotherapy was not statistically significant (P = .66); therefore, newly treated DPN patients should add on another medication sooner than 30 days when considering combination pharmacotherapy. All first-line medications have similar efficacy; for this reason, cost should be considered in the treatment decision.