To describe treatment patterns among patients with painful diabetic peripheral neuropathy (pDPN) in the United States.

Current treatment options to manage symptoms of pDPN are associated with limited effectiveness and/or poor tolerability for many patients. High discontinuation rates of commonly prescribed therapies have been reported in previous research, which may contribute to inadequately controlled pain and high unmet needs. This study provides an analysis of real-world treatment patterns using a contemporary dataset.

A retrospective, observational study was conducted using the MarketScan database [1/1/2016-06/30/2023] to identify adults diagnosed with DPN and newly prescribed neuropathic pain medication(s) for pDPN [index treatment] within 60 days of DPN diagnosis. Patients with prior use of pain medication, diagnoses for conditions with similar medication indications, malignancy or metastatic disease, or major surgery were excluded. Treatment patterns during a 12-month follow-up were reported, including the frequency and type of medication, dosage, adherence, discontinuation, switching, and addition.

Among the 22,955 patients identified, 98.5% initiated pDPN treatment with monotherapy. The majority of patients (64.3%) initiated treatment with gabapentinoids (gabapentin 59.0%; pregabalin 5.3%), followed by opioids (tramadol 15.1%, oxycodone 6.9%), and antidepressants (duloxetine 5.2%). Most patients receiving gabapentinoids or antidepressants were not titrated up to the FDA recommended dosages and adherence was low over the 12 months of follow-up. Majority of patients discontinued all index treatments within 1 year (76.8%), with 73.4% of those discontinuing within 3 months of initiation. The 1-year discontinuation rates for patients indexing on tramadol, pregabalin, gabapentin, and duloxetine were 96.8%, 74.5%, 69.9%, and 63.8%, respectively. Among patients who discontinued index treatment, <35% switched to another pain medication during the 12-month follow-up period.

High discontinuation rates and suboptimal adherence may indicate limited effectiveness and/or poor tolerability of pDPN treatments. New therapies with better efficacy, safety, and tolerability are needed to address unmet needs of pDPN patients.