Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy. (2nd July 2016)

• Record Type: Journal Article
• Authors: Kuo, Kuan-Ling; Brixner, Diana; Lipman, Arthur G.; Goodman, Michael; Hung, Man; Oderda, Gary M.
• Is Part Of: Journal of pain & palliative care pharmacotherapy. Volume 30:Number 3(2016)
• Page Start: 184
• Page End: 194
• Publication Date: 2016-07-02
• Subjects: combination therapy -- costs -- diabetic -- monotherapy -- neuropathy -- outcomes -- painful -- patient characteristics -- pharmacotherapy; Pain -- Treatment -- Periodicals; Analgesia -- Periodicals; Palliative treatment -- Periodicals; Analgesics -- Therapeutic use -- Periodicals; Pain -- drug therapy -- Periodicals; Pain -- prevention & control -- Periodicals; Palliative Care -- Periodicals; Analgesics -- therapeutic use -- Periodicals; 616.994
• DOI: 10.1080/15360288.2016.1210713
• Languages: English
• ISSNs: 1536-0288

Abstract

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.