The clinical effectiveness and safety of alprostadil combined with alpha lipoic acid in the treatment of diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis

A novel approach to alpha-lipoic acid therapy in the treatment of diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is a heterogenic disorder prevalent amongst patients suffering from diabetes mellitus (DM), with symptoms comprising neuropathic pain, paresthesia, and numbness in distal lower limbs. Alpha-lipoic acid (ALA) is proposed as a pathogenesis-oriented treatment option, targeting underlying causes of neural lesions such as hyperglycemia, metabolic and microvascular dysfunctions, and cellular oxidative stress. We performed a comprehensive review of controlled clinical trials demonstrating the clinical usefulness of ALA in the treatment of DPN, published in the last 5 years to determine the benefits of ALA monotherapy and combined treatments with other known antioxidants. We also investigated the differential efficacy of oral versus intravenous ALA administration. Clinical trials show the efficacy of ALA treatment, attributed to its anti-inflammatory, anti-hyperglycemic, and antioxidant properties, as well as its function in the endothelial activation and lipid metabolism parameters. ALA supplementation is associated with amelioration in nerve conduction velocity scores, clinically significant reduction of reported neuropathic pain, burning and paresthesia, as well as a decrease in serum triglycerides, improved insulin sensitivity, and quality of life.

Efficacy of administrative intervention for neurosurgical patients with off-label use of alprostadil lipid microsphere

As an adjuvant drug, alprostadil lipid microsphere injection (Lipo-PGE₁) is one of the best-selling drugs in China in recent years. However, the off-label use of Lipo-PGE₁ is very common. This study aimed to investigate the use of Lipo-PGE₁ and evaluate the clinical effects and economic benefits after administrative intervention on inappropriate use of Lipo-PGE₁ in neurosurgical patients in a Chinese tertiary hospital. Administrative interventions were implemented from January to December 2018 by reducing the procurement volume of Lipo-PGE₁, judging the rationality of medical records, and establishing reward and punishment mechanisms. Administrative interventions significantly decreased prescription rate (49.98% vs 22.49%), utilization (22,311 DDDs vs 8334 DDDs), drug use density (43.52 DDDs/TID vs 15.84 DDDs/TID), total expenditure (3.58 million RMB vs 1.30 million RMB), and average expenditure (2025.04 RMB vs 1466.49 RMB) of Lipo-PGE₁. To our delight, these intervention effects were maintained or even better in the 1-year post-intervention period. Moreover, in the intervention and post-intervention phases, the Lipo-PGE₁ use for no indications as well as inappropriate drug dose, frequency, menstruum type, combination, and contraindication were markedly reduced. Besides, the mean costs (P < 0.001), and mean duration (P < 0.001) of Lipo-PGE₁ were also obviously decreased. The administrative intervention obviously reduced the off-label use of Lipo-PGE₁. However, there still remains a number of inappropriate uses of Lipo-PGE₁. To further improve the rational use of Lipo-PGE₁, combination of administrative intervention and real-time clinical pharmacists intervention should be implemented.

Efficacy of epalrestat combined with alprostadil for diabetic nephropathy and its impacts on renal fibrosis and related factors of inflammation and oxidative stress

OBJECTIVE

To explore the efficacy of epalrestat (Ep) combined with alprostadil (Alp) in the treatment of diabetic nephropathy (DN) and its impacts on renal fibrosis (RF) and inflammation and oxidative stress (OS)-related factors.

METHODS

In this retrospective study, 120 patients with DN treated in the Cangzhou Central Hospital from January 2020 to January 2021 were selected as the research subjects. Among them, 80 cases treated with Ep combined with Alp were assigned to group A, and the rest 40 patients treated with Alp only were assigned to group B. The two groups were compared with respect to the following items: serum OS indexes (malondialdehyde, MDA; superoxide dismutase, SOD; total antioxidant capacity, TAOC), inflammatory factors (tumor necrosis factor-α, TNF-α; interleukin-2, IL-2), RF index transforming growth factor-β1 (TGF-β1), urinary protein indexes (urinary albumin excretion, UAE; serum albumin, ALB), blood glucose (fasting blood glucose, FBG), fasting C-peptide, postprandial 2hC peptide levels, overall response rate (ORR) and incidence of adverse reactions.

RESULTS

Compared with group B, the levels of MDA, TNF-α, IL-2 and TGF-β1 were lower, while SOD and TAOC were higher in group A. In addition, ALB was higher, while UAE and FBG were lower in group A as compared with group B. Moreover, group A had a higher ORR and fewer adverse reactions as compared with group B.

CONCLUSION

The combined therapy of Ep and Alp is more effective in the treatment of DN. This combination can effectively reduce RF and better alleviate inflammation and OS.

Therapeutic effect of opioid analgesics combined with non-steroidal anti-inflammatory drugs on peripheral neuropathy and its influence on inflammatory factors

OBJECTIVE

To study the therapeutic effect of opioid analgesics combined with non-steroidal anti-inflammatory drugs on peripheral neuropathy and inflammatory factors.

METHODS

Clinical data of 60 patients with peripheral neuropathy were collected and studied retrospectively. The patients were divided into Group A (30 cases, treated with tramadol combined with ibuprofen) and Group B (30 cases, treated with tramadol alone). The visual analogue scale (VAS) and numerical rating scale (NRS) pain scores were recorded before and 3, 7, 14 and 21 days after taking the medicine. The adverse reactions of nausea, vomiting, gastrointestinal disorder, dizziness, rash and lethargy were recorded within 21 days after taking the medicine. Blood samples were obtained from patients before and 3, 7, 14 and 21 days after taking medicine to detect the inflammatory factors IL-6, IL-1β and TNF-α.

RESULTS

VAS and NRS scores of patients in Group A were significantly lower than those of patients in Group B after 7, 14 and 21 days of treatment (all P<0.05), but there was no significant difference in VAS and NRS scores between the two groups after 3 days of treatment (all P>0.05). The incidence of gastrointestinal disturbance in Group A was significantly higher than that in Group B (P<0.001). There was no significant difference in IL-6, IL-1β and TNF-α between the two groups 3 days after treatment (all P>0.05), but after 7, 14 and 21 days of treatment, the levels of IL-6, IL-1β and TNF-α in Group A were significantly lower than those in Group B (all P<0.05).

CONCLUSION

Opioid analgesics combined with non-steroidal anti-inflammatory drugs is better than opioid analgesics alone in the treatment of peripheral neuropathy, and brings no more adverse reactions except gastrointestinal disorders, so the combined treatment can be further promoted for clinical use.