Effectiveness of duloxetine in treatment of painful chemotherapy-induced peripheral neuropathy: a systematic review

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect that can be dose limiting and affect patient quality of life. To date, the therapeutic options for CIPN are limited. We performed a systematic literature search of the PubMed and Scopus databases to assess the effectiveness of duloxetine in the treatment of pain in patients with CIPN. The search included randomized controlled trials, nonrandomized controlled trials, retrospective studies, and single-arm studies of duloxetine in treatment of CIPN. A descriptive analysis of the studies was performed. The PubMed database online search identified 41 publications, and a second database search through Scopus identified 29 publications. A total of 10 full-text articles were assessed for eligibility, with 5 articles excluded. Altogether, the included studies reported 431 patients with painful CIPN. An improvement in pain scores was the primary and/or secondary endpoint in the included studies. Pain was assessed by 6 different scores. Comparator drugs were used in 4 studies in our review. The comparator drug was placebo in 1 study only, and the remaining 3 studies used other antineurotoxicity therapy. The chemotherapeutic agents used in the studies were the following: paclitaxel (52.9%), oxaliplatin (39.7%), R-CHOP (rituximab, doxorubicin, vincristine, and cyclophosphamide; 3.30%), combined bortezomib-dexamethasone (1.89%), FOLFOX (folinic acid, fluorouracil, and oxaliplatin; 1.18%), and other taxanes (0.94%). From the descriptive analyses, and from the available data of relatively small sample sized studies, it can be concluded that despite the above limitations, duloxetine remains a useful therapeutic option for pain in CIPN patients, regardless of the type of chemotherapeutic agent used.