Response from author: Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review
Julie MWaldfogel, Clinical Pharmacy Specialist, The Johns Hopkins Hospital
Lisa MWilson, Research Coordinator, Johns Hopkins Bloomberg School of Public Health
Karen ARobinson, Associate Professor, Johns Hopkins Bloomberg School of Public Health
Submitted March 07, 2018
We thank Parsons et al. for their interest in our article. [1] Parsons et al. indicated concern regarding our reference to reporting bias for pregabalin and note Pfizer’s commitment to publishing company-sponsored research. We appreciate this and have included all available data that met eligibility criteria in our analysis. The results of our search for each drug— including counts of studies completed without available result— can be found in Table e-2. [1] Concerning the published pooled analysis, [2] this included studies that did not meet our eligibility criteria. As a result, the pooled analysis was not included in our review.
In addition, Parsons et al. questioned the strength of evidence (rated as low) for pregabalin despite its recommendation as a first-line treatment for DPN by several professional societies. Strength of evidence is based on several factors including study limitations, directness, consistency, precision, and reporting bias. None of the professional society references provided by Parsons et al. reviewed data after 2013 and three of the five reviewed data from 2010 or earlier in their recommendation development. Five of the 15 studies included in our pregabalin analysis were published in 2014 or later, eight of the 15 in 2011 or later.
Finally, Parsons et al. noted quality of life results should be interpreted within the context that studies were powered with pain severity as the primary outcome. We agree. Regardless, specific results were often not reported (only whether outcomes were statistically significant). We reaffirm that more specific reporting of these secondary outcomes would be beneficial for future research.
1. Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology 2017;88:1958-1967.
2. Parsons B, Li C. The efficacy of pregabalin in patients with moderate and severe pain due to diabetic peripheral neuropathy. Curr Med Res Opin 2016;32:929-937.
We thank Parsons et al. for their interest in our article. [1] Parsons et al. indicated concern regarding our reference to reporting bias for pregabalin and note Pfizer’s commitment to publishing company-sponsored research. We appreciate this and have included all available data that met eligibility criteria in our analysis. The results of our search for each drug— including counts of studies completed without available result— can be found in Table e-2. [1] Concerning the published pooled analysis, [2] this included studies that did not meet our eligibility criteria. As a result, the pooled analysis was not included in our review.
In addition, Parsons et al. questioned the strength of evidence (rated as low) for pregabalin despite its recommendation as a first-line treatment for DPN by several professional societies. Strength of evidence is based on several factors including study limitations, directness, consistency, precision, and reporting bias. None of the professional society references provided by Parsons et al. reviewed data after 2013 and three of the five reviewed data from 2010 or earlier in their recommendation development. Five of the 15 studies included in our pregabalin analysis were published in 2014 or later, eight of the 15 in 2011 or later.
Finally, Parsons et al. noted quality of life results should be interpreted within the context that studies were powered with pain severity as the primary outcome. We agree. Regardless, specific results were often not reported (only whether outcomes were statistically significant). We reaffirm that more specific reporting of these secondary outcomes would be beneficial for future research.
1. Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology 2017;88:1958-1967.
2. Parsons B, Li C. The efficacy of pregabalin in patients with moderate and severe pain due to diabetic peripheral neuropathy. Curr Med Res Opin 2016;32:929-937.
For disclosures, please contact the editorial office at journal@neurology.org.