title: Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy.
abstract: 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.
authors.forename: Kuan-Ling
authors.initials: KL
authors.lastname: Kuo
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Lipman
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.forename: Gary M
authors.initials: GM
authors.lastname: Oderda
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003929:Diabetic Neuropathies / Q000188:drug therapy / Q000191:economics; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: combination therapy; costs; diabetic; monotherapy; neuropathy; outcomes; painful; patient characteristics; pharmacotherapy