A Systematic Literature Review And Network Meta-Analysis of Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for The Treatment of Painful Diabetic Peripheral Neuropathy.

INTRODUCTION • Neuropathies, characterised by damage to peripheral nerve fibres, are a common long-term complication of diabetes.1 – Painful diabetic neuropathy occurs in 10% to 20% of patients with diabetes.2,3 – Symptoms adversely affect health-related quality of life,4 and can cause sleep problems, anxiety and depression.5 • Painful diabetic peripheral neuropathy (PDPN) is a challenging condition to treat. – Evidence-based treatment guidelines recommend oral agents, including anticonvulsants, tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors.3,6–8 – Localised and topical treatments are also recognised options,3,6–8 including the capsaicin 8% patch (QUTENZATM) that has been shown to elicit pain relief in non-diabetic patients with peripheral neuropathic pain.9–12 – Two phase III randomised controlled trials (RCTs), STEP13 and PACE,14 that evaluated the capsaicin 8% patch in patients with PDPN have recently been completed, leading to an European label extension for the use in adult diabetic patients with peripheral neuropathic pain, either alone or in combination with other pain medications.15 – Currently, there is no direct clinical evidence comparing the capsaicin 8% patch to oral agents in patients with PDPN.