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July 14, 1999

Gabapentin for Painful Diabetic Neuropathy

JAMA. 1999;282(2):133-134. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-2-jbk0714

To the Editor: I was dismayed by the placebo-controlled design of the study by Dr Backonja and colleagues1 that examined the effectiveness of gabapentin in patients with diabetic neuropathy. As the authors clearly state, the use of tricyclic antidepressants is well established and effective for the treatment of painful diabetic neuropathy. The use of a placebo control for a condition for which there is an effective treatment, even for the short duration of this trial, is in my opinion unethical. Furthermore, a comparison of outcomes using a new treatment with an established treatment is of considerably more clinical importance than comparison with a placebo. Although tricyclic antidepressants may have adverse effects that limit their tolerability for some patients, dizziness, somnolence, and confusion were common adverse effects with gabapentin. The considerable cost differences between gabapentin and tricyclic antidepressants make a direct comparison of these treatments of paramount interest. The cost of a 30-day supply of a 900-mg/d dose of gabapentin, which is one fourth of the maximum dose titration in this study, is $93.2 In comparison, the cost of a 30-day supply of generic formulations of amitriptyline and nortriptyline is $3 and $12, respectively.3