title: Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy.
abstract: OBJECTIVE
  To compare the efficacy and safety of daily lipoic acid (300-600 mg i.v.) plus methylcobalamin (500-1000 mg i.v. or im.) (LA-MC) with that of methylcobalamin alone (MC) on diabetic peripheral neuropathy (DPN).
  
  
  METHODS
  Electronic database were searched for studies published up to November 1, 2012 and study quality was assessed in duplicate. A random or a fixed effect model was used to analyse outcomes which were expressed as risk ratios (RRs) or mean difference (MD). I(2) statistic was used to assess heterogeneity.
  
  
  RESULTS
  Seventeen studies were included. Combined data from all studies showed that the LA-MC combination therapy was significantly superior to MC monotherapy (RR=1.47; 95% CI: 1.37-1.58). Superiority of the LA-MC combination was shown in nerve conduction velocity (NCV) with WMDs of 6.89 (95% CI: 4.24-9.73) for median motor nerve conduction velocity (MNCV), 5.24 (4.14-6.34) for median sensory nerve conduction velocity (SNCV), 4.34 (3.03-5.64) for peroneal MNCV, and 4.53 (3.2-5.85) for peroneal SNCV. There were no serious adverse events associated with treatment.
  
  
  CONCLUSIONS
  The results of the meta-analysis show that treatment with LA-MC for 2-4 weeks is associated with better outcomes in NCV and neuropathic symptoms relative to MC treatment. However larger well-designed studies are required to confirm this conclusion.
authors.affiliation: Department of Pharmacy, Zhu-Jiang Hospital, Southern Medical University, Guangzhou, China. xiaoqian7666@163.com
authors.forename: Qian
authors.initials: Q
authors.lastname: Xu
authors.forename: Jianhong
authors.initials: J
authors.lastname: Pan
authors.forename: Jingwen
authors.initials: J
authors.lastname: Yu
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Xialin
authors.initials: X
authors.lastname: Zuo
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.forename: Houliang
authors.initials: H
authors.lastname: Deng
authors.forename: Jingjing
authors.initials: J
authors.lastname: Zhang
authors.forename: Aimin
authors.initials: A
authors.lastname: Ji
mesh_terms: D003929:Diabetic Neuropathies / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy*; D008063:Thioctic Acid / Q000627:therapeutic use*; D014805:Vitamin B 12 / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D008063:Thioctic Acid; C019476:mecobalamin; D014805:Vitamin B 12
keywords: Combination therapy; Diabetic peripheral neuropathy; Lipoic acid; Meta-analysis; Methylcobalamin