Antidepressant Cymbalta May Reduce Pain from Chemotherapy-Induced Peripheral Neuropathy
The antidepressant Cymbalta® (duloxetine) appears to reduce the numbness and tingling associated with taxane or platinum-based chemotherapy, according to the results of a study published in the Journal of the American Medical Association.
Peripheral neuropathy refers to numbness and tingling of the extremities (hands and feet) and is caused by damage to the nerves between the extremities and the central nervous system (CNS). About 20 to 40 percent of patients treated with neurotoxic chemotherapy agents such as taxanes, platinums, and vinca alkaloids will experience this painful condition. Because the condition can have a lasting impact on day-to-day life, researchers continue to search for ways to mitigate this pain.
Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) that works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance and stop the movement of pain signals in the brain.
Researchers conducted a phase 3, randomized, double-blinded, placebo-controlled crossover trial to test the effectiveness of Cymbalta on pain associated with painful chemotherapy-induced peripheral neuropathy. The study included 220 adult patients (age 25 or older) with grade I or higher chemotherapy-induced peripheral neuropathy.
Patients were randomized one-to-one to receive either Cymbalta or placebo for five weeks and then after a two-week “washout” period, they were switched to receive the opposite treatment for five weeks. Cymbalta dosing started at 30 mg daily for the first week and then increased to 60 mg daily for 4 weeks.
Over the course of five weeks, patients receiving Cymbalta experienced a significantly larger reduction in pain compared to those receiving placebo. What’s more, a larger proportion of patients initially treated with Cymbalta than with placebo reported pain decreases of any amount (59% vs. 38%). Patients who received platinum-based chemotherapy experienced more benefit from Cymbalta than those who received taxane-based chemotherapy.
Cymbalta also appeared to reduce the impact of pain on daily life. The interference scores (indicating impact on activity, mood, walking, work, relationships, sleep, and enjoyment of life) declined significantly more in the Cymbalta group.
The researchers concluded that among patients with painful chemotherapy-induced peripheral neuropathy, the use of Cymbalta compared with placebo for 5 weeks resulted in a greater reduction in pain.
Lavoie-Smith EM, Pang H, Cirrincione C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: A randomized clinical trial. JAMA. 2013; 309(13):1359-1367.
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