From the Guidelines
Tricyclic anti-depressants, such as amitriptyline, have one of the lowest numbers needed to treat (NNT) for painful diabetic peripheral neuropathy, with an NNT of 1.5-3.5 1. When considering the treatment of painful diabetic peripheral neuropathy, it is essential to evaluate the effectiveness of various medications.
- The NNT is a crucial metric in determining the efficacy of a treatment, as it represents the number of patients who need to receive the treatment for one patient to benefit.
- Tricyclic anti-depressants, particularly amitriptyline, have been shown to have a relatively low NNT, indicating their potential as an effective treatment option for this condition.
- Other treatment options, such as serotonin noradrenalin re-uptake inhibitors (e.g., duloxetine) and anti-convulsants (e.g., gabapentin, pregabalin), may also be considered, but their NNT values are not as well-established as those for tricyclic anti-depressants 1.
- It is essential to note that the NNT values can be influenced by various factors, including the specific patient population, dosage, and duration of treatment.
- When prescribing tricyclic anti-depressants, such as amitriptyline, it is crucial to start with a low dose (e.g., 10 mg/day) and gradually increase as needed, while monitoring for potential side effects, particularly in older patients or those with a history of cardiovascular disease 1.
From the Research
Medicines with Low Number Needed to Treat
Some medicines have a low number needed to treat (NNT) to prevent certain events.
- Aspirin has an NNT of 67 to prevent 1 death from any cause of mortality 2
- Aspirin has an NNT of 100 to detect 1 nonfatal gastrointestinal tract bleeding 2
- Aspirin has an NNT of 345 to reduce the risk of cardiovascular events (CV events) 3
- Aspirin has an NNT of 488 to reduce the risk of myocardial infarction 3
- Aspirin has an NNT of 476 to reduce the risk of ischemic stroke 3
Comparison of NNT Values
Comparing the NNT values of different treatments:
- Antidyslipidemic therapy has an NNT of 53 to prevent a nonfatal MI and 190 to prevent all-cause death in primary prevention 4
- Antidyslipidemic therapy has an NNT of 37 to prevent death from any cause in secondary and tertiary prevention 4
- A combination therapy with aspirin, an ACE inhibitor, and a statin reduces 1-year mortality in patients after acute myocardial infarction, with an odds ratio of 1.67 for 0-1 drug and 1.54 for 2 drugs compared to the group treated with all 3 drugs 5
- Aspirin for primary prevention significantly reduced all cardiovascular events by 15% and myocardial infarctions by 30%, with an NNT of 44 to prevent a myocardial infarction at coronary event risk 1.5%/year 6