Ranking Alpha Lipoic Acid and Gamma Linolenic Acid in Terms of Efficacy and Safety in the Management of Adults With Diabetic Peripheral Neuropathy: A Systematic Review and Network Meta-analysis

• Published in: Canadian journal of diabetes 2024-06, Vol.48 (4), p.233-243.e10
• Main Authors: Prado, Mario B., Adiao, Karen Joy B.
• Format: Article
• Language: English
• Subjects: acide alpha-lipoïque; acide gamma-linolénique; alpha lipoic acid; diabetic neuropathy; gamma linolenic acid; méta-analyse en réseau; network meta-analysis; neuropathie diabétique
• ISSN: 1499-2671; 2352-3840; 2352-3840
• DOI: 10.1016/j.jcjd.2024.01.007

Current medications for diabetic neuropathy (DN) recommended by the American Diabetes Association and American Academy of Neurology do not address the pathologic process of denervation among patients with DN, because ancillary treatments, such as reactive oxygen scavengers, may be needed. The purpose of this work was to summarize the available evidence about the efficacy and safety of alpha lipoic acid (ALA) and gamma linolenic acid (GLA) in the management of DN. Using the search terms [(alpha lipoic acid or ALA or thioctic acid or thioctacid) or (gamma linolenic acid or GLA)] AND [(diabetes or diabetes mellitus) AND (polyneuropathy or neuropathy or sensorimotor polyneuropathy or radiculopathy)], 11 studies were included in this review and combined meta-analysis. Eight of the 11 articles (73%) reported significant benefit of ALA vs placebo. In the meta-analysis, the Total Symptom Score (TSS) for ALA 600 mg/day (ALA600) was 1.05 points lower (standard mean difference [SMD] −1.05, 95% confidence interval [CI] −2.07 to −0.04, p=0.04, I2=98.18%) compared with control at the end of the study. In the network meta-analysis, ALA600 (SMD −1.68, 95% CI −2.8 to −0.6) and GLA (SMD −2.39, 95% CI −4.3 to −0.5) had significantly lower TSSs compared with placebo. Moreover, GLA had the highest probability of being the best (52.7%) for improving DN symptoms. In all studies, most adverse events include gastrointestinal disturbances. In terms of tolerability, no differences were detected between ALA and control groups. ALA and GLA appear to be safe and efficacious biofactors for improvement of DN symptoms. Les médicaments actuels contre la neuropathie diabétique (ND), qui sont recommandés par l’American Diabetes Association (ADA) et l’American Academy of Neurology (AAN), ne traitent pas le processus pathologique de la dénervation chez les patients atteints de ND. Par conséquent, des traitements complémentaires tels que les piégeurs des espèces réactives de l’oxygène (ERO) peuvent être nécessaires. L’objectif du présent article est de résumer les données probantes disponibles sur l’efficacité et l’innocuité de l’acide alpha-lipoïque (AAL) et de l’acide gamma-linolénique (AGL) dans la prise en charge de la ND. À partir des termes d’interrogation [(acide alpha-lipoïque ou AAL ou acide thioctique ou thioctacide) ou (acide gamma-linolénique ou AGL)], et [(diabète ou diabète sucré), et (polyneuropathie ou neuropathie ou polyneuropathie sensitivomotrice ou radiculopathie)], nous avo