title: Impact of comorbidities on pharmacotherapy of painful diabetic neuropathy in clinical practice.
abstract: OBJECTIVE
  We evaluated the impact of baseline comorbidities on the effectiveness of duloxetine and anticonvulsants (pregabalin/gabapentin) in patients with painful diabetic neuropathy in clinical care.
  
  
  METHODS
  Outcomes from a 6-month, observational study with 2575 patients initiating/switching DPNP treatment were analyzed post-hoc. Propensity scoring was used to adjust for baseline factors influencing treatment choice in 1523 patients receiving duloxetine or anticonvulsants. Analysis of covariance models with fixed effects for baseline pain, treatment, propensity score, baseline characteristics or comorbidities, and their interaction with treatment were used to estimate LSmean effects on Brief Pain Inventory (BPI) average pain and interference scores.
  
  
  RESULTS
  89.5% of patients reported comorbidities, including hypertension (70.5%), hyperlipidemia (39.2%), and depression (24.8%). Macrovascular complications (37.0%) and 'other chronic pain' (41.5%), particularly joint pain had an impact on both pain treatments, i.e. less improvement of average pain and interference of pain. Better treatment responses with duloxetine vs. anticonvulsants were observed in patients with depression, those with high baseline BPI total interference score, especially general activity, and in patients with joint pain.
  
  
  CONCLUSIONS
  Comorbidities such as macroangiopathy and depression as well as pain characteristics should be considered in the treatment of DPNP as they may predict the effectiveness of duloxetine and anticonvulsants.
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University; Department of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany. Electronic address: dan.ziegler@ddz.uni-duesseldorf.de.
authors.forename: Dan
authors.initials: D
authors.lastname: Ziegler
authors.affiliation: Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany.
authors.forename: Edith
authors.initials: E
authors.lastname: Schneider
authors.affiliation: Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Boess
authors.affiliation: Lilly Deutschland GmbH, Global Statistical Sciences, Bad Homburg, Germany.
authors.forename: Lovisa
authors.initials: L
authors.lastname: Berggren
authors.affiliation: Klinik und Poliklinik für Neurologie, Johannes Gutenberg Universität, Mainz, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Birklein
mesh_terms: D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D015897:Comorbidity; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000068736:Duloxetine Hydrochloride; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D000069583:Pregabalin; D011379:Prognosis; D012189:Retrospective Studies; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000068736:Duloxetine Hydrochloride
keywords: Anticonvulsants; DPNP; Duloxetine; Gabapentin; Pregabalin