What are the new treatments for improving nerve function in patients with polyneuropathy (Peripheral Neuropathy)?

From the Guidelines

For patients with polyneuropathy, particularly those with amyloid neuropathy, disease-directed therapy with TTR silencers such as patisiran, inotersen, or vutrisiran can slow progression and/or reverse disease, while symptomatic management with medications like pregabalin, gabapentin, and duloxetine can help alleviate neuropathic pain. When considering treatment options, it's essential to prioritize the most recent and highest quality studies. According to the 2023 study 1, TTR silencers have shown promise in slowing disease progression and reversing symptoms in patients with ATTRv amyloidosis. Symptomatic management is also crucial, with medications like pregabalin, gabapentin, and duloxetine providing relief for neuropathic pain. Some key points to consider when managing polyneuropathy include:

• Disease-directed therapy with TTR silencers for patients with ATTRv amyloidosis
• Symptomatic management with medications like pregabalin, gabapentin, and duloxetine for neuropathic pain
• Autonomic dysfunction management with medications like fludrocortisone, midodrine, or droxidopa
• Importance of combination therapy using low doses of multiple medications to achieve better relief with fewer side effects It's also important to note that the effectiveness of these treatments may vary depending on the underlying cause of polyneuropathy, as highlighted in the 2023 study 1. Additionally, the 2010 study 1 suggests that combination therapy can be beneficial in achieving better pain relief with fewer side effects. However, the most recent and highest quality study 1 should be prioritized when making treatment decisions.

From the FDA Drug Label

Pregabalin is indicated for: Management of neuropathic pain associated with diabetic peripheral neuropathy Management of postherpetic neuralgia Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older Management of fibromyalgia Management of neuropathic pain associated with spinal cord injury

The drug label for pregabalin 2 mentions management of neuropathic pain associated with diabetic peripheral neuropathy and spinal cord injury, but it does not specifically mention improving nerve function for polyneuropathy.

• The label indicates pregabalin is used for managing neuropathic pain, not directly for improving nerve function.
• Pregabalin may help with symptoms of polyneuropathy, such as neuropathic pain, but it is not explicitly stated to improve nerve function.

From the Research

Current Treatments for Polyneuropathy

• The treatment of polyneuropathy includes symptomatic therapy of sensory, motor, and autonomic dysfunctions 3.
• Current treatment guidelines recommend calcium-channel anticonvulsants gabapentin/pregabalin and antidepressants duloxetine and amitriptyline as first-line therapeutics 3.
• Topical therapeutics can be used in the case of localized disorders, and opioids or other antidepressants/anticonvulsants may be effective in individual cases 3.

Emerging Therapies for Diabetic Polyneuropathy

• There is emerging evidence highlighting a reduction in vitamin D levels in cases of painful diabetic polyneuropathy (DPN) and the potential for vitamin D supplementation in deficient individuals to improve neuropathic pain 4.
• Innovative approaches such as the topical 8% capsaicin patch, new methods of electrical stimulation, and novel therapeutic targets such as NaV1.7 offer promise for the future 4.
• Dorsal column spinal cord stimulation (SCS) has been shown to be effective in treating PDN, with level I evidence supporting its use 5.

Pharmacological Management of Painful Peripheral Neuropathies

• The best available evidence for the management of painful diabetic polyneuropathy (DPN) is for amitriptyline, duloxetine, gabapentin, pregabalin, and venlafaxine as monotherapies and oxycodone as add-on therapy 6.
• Tramadol appears to be effective when used as a monotherapy and add-on therapy in patients with polyneuropathy (PN) of various etiologies 6.
• Response to treatment may be affected by the underlying pathophysiological mechanisms involved in the pathogenesis of the PN, highlighting the importance of thorough investigation to determine the causes of the neuropathy 6.

Importance of Early Diagnosis and Treatment

• Early diagnosis of polyneuropathy is crucial to initiate appropriate specific treatment and slow its progression 4, 7.
• A timely diagnosis of the cause of polyneuropathy is a prerequisite for the initiation of appropriate specific treatment, and patients with severe neuropathy of unidentified cause should be referred to a specialized center for a thorough diagnostic evaluation 7.