SLR- December 2013- Stephen Moore and Mohammed Farooqui
Reference: Fonseca VA., Lavery LA, Thethi TK, DaoudY, Ovalle F, Denham DS, Bottigleieri T, Sheehan P, Rosenstock J. Metanx in Type 2 Diabetes with Peripheral Neuropathy: A Randomized Trial. American Journal of Medicine. 2013 Feb;126(2):141-9.
Scientific Literature Review
Reviewed By: Stephen Moore and Mohammed Farooqui
Residency Program: Hunt Regional Medical Center - Greenville, TX
Podiatric Relevance: Podiatrists commonly treat neuropathic pain in diabetic patients. This article evaluates the effectiveness of Metanx in treating neuropathic painand evaluates if it can improve sensation.
Methods: 214 patients were involved in a multicenter, double-blinded, placebo controlled trial. Age of participants ranged from 25-80 years. Inclusion criteria were all patients with type 2 diabetes with peripheral neuropathy, as measured by vibration perception threshold. Patients were randomly assigned Metanx or placebo for 24 weeks. Exclusion criteria consisted of patients with peripheral vascular disease, history of vascular bypass surgery, amputation or ulceration within two years, Charcot neuroarthropathy, severe arthritis, HgbA1c >9 percent and uncontrolled hypertension as defined by>160/90.
Results: A variance model of statistical analysis was performed, including Fisher's exact test, chi-squared analysis, t test, linear models, Type III tests, as well as WALD z-tests. Assessments were made for vibration perception threshold and visual analog scale among others. The vibration perception threshold did not vary significantly in both groups. Neuropathic symptoms improved significantly, and patients who experienced disability due to the neuropathy improved significantly as well.
Conclusions: In comparison to the placebo, Metanx significantly improved neuropathic symptoms at 16 and 24 weeks of treatment. Patients treated with Metanx also reported a statistically significant increase in quality of life. Metanx may be an effective short-term treatment for peripheral neuropathy pain.