Publication Description
The efficacy of tolrestat in the treatment of diabetic peripheral neuropathy. A meta-analysis of individual patient data.
A Nicolucci ,
F Carinci ,
J G Graepel ,
T C Hohman ,
F Ferris and
J M Lachin
Department of Clinical Pharmacology and Epidemiology-Istituto di Ricerche Farmacologiche Mario Negri, S. Maria Imbaro (CH),
Itlay. [email protected]
Abstract
OBJECTIVE: The aim of this meta-analysis was to review the existent evidence on the effectiveness of tolrestat in the treatment
of diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: Individual patient data on 738 subjects from the three randomized
clinical trials published on this topic were analyzed using changes in motor nerve conduction velocities (NCVs) as endpoints.
Nerves investigated included median, ulnar, tibial, and peroneal. RESULTS: The pooled analysis of NCV taken as a continuous
measurement showed a significant treatment effect, the magnitude of this benefit being approximately equal to 1 m/s for all
the nerves investigated. When looking at the proportion of patients experiencing a loss of NCV of at least 1 or 2 m/s in at
least two out of the four nerves investigated, it emerged that treatment reduced by > 40% the risk of such outcomes after
adjusting for patients' characteristics. The odds ratios relative to the placebo group were 1.82 (1.30-2.52) and 1.70 (1.15-2.48)
for a decrease of 1 and 2 m/s, that is, placebo-treated patients have an 82 and 70% increased risk for a loss of nerve function
of 1 and 2 m/s, respectively. No statistically significant difference in treatment effect emerged after stratification according
to baseline motor NCV and glycated hemoglobin levels. CONCLUSIONS: After a treatment duration ranging between 24-52 weeks,
patients treated with tolrestat had a reduced risk for developing nerve function loss compared with placebo-treated patients.
Future long-term trials are needed to evaluate the impact of the treatment on more clinically meaningful endpoints such as
the development of foot complications.