Meta-analysis Of Prostaglandin E1 Combined With Alpha Lipoic Acid In Treatment Of Diabetic Peripheral Neuropathy

Objective: This article evaluates the efficacy and safety of alprostadil combined with lipoic acid in the treatment of diabetic peripheral neuropathy by a meta-analysis of published randomized controlled trials.Methods: We systematically searched and screened randomized controlled trials treating diabetic peripheral neuropathy with alprostadil and lipoic acid,published in Chinese and English electronic database as of January 2019.We used Excel spreadsheet to performed data extraction,our main endpoint were clinical efficacy and symptom scores(including the Toronto Clinical Scoring System,the Total symptom score,the Visual analogue scale),nerve conduction velocity,and adverse reactions.Results: 1.Of 439 identified studies,34 were eligible and were included in our analysis(N=2998 participants),all of which were included in the Chinese literature.2.The clinical efficacy of prostaglandin E1 combined with lipoic acid was better than that of prostaglandin E1 alone(RR =1.30,95% CI:1.24~1.38,Z=11.46,p<0.01).,lipoic acid(RR=1.27,95% CI:1.17~1.38,Z = 5.83,p <0.01).2.In the improvement of clinical symptom score,the improvement of TCSS and VAS in the combination treatment group was better than that in the single drug group(TCSS: overall WMD =-1.29,95% CI-1.49 ~-1.08,Z = 12.12,p<0.01;VAS overall WMD =-1.32,95% CI :-1.61~-1.04,Z=9.04,p<0.01).There was no significant difference in the improvement of TSS between the combination group and the lipoic acid group alone(WMD =-0.83,95% CI :-1.81~0.15,Z=1.68,p>0.05),and is superior to the prostaglandin E1 group(WMD=-1.84,95% CI :-2.27~-1.40,Z=8.30,p <0.01).3.In the recovery of nerve conduction velocity,the combination treatment group showed more obvious effect.After treatment,in the motor nerve,the WMD of the median MNCV was 4.61(95% CI: 3.91~5.30,Z=12.95,p<0.01),and the WMD of peroneal MNCV was 4.62(95% CI:3.87~5.37,Z=12.05,p<0.01);in the sensory nerve,WMD of median SNCV was 4.53(95% CI:4.18~4.87,Z=25.64,p<0.01),the peroneal SNCV WMD was 4.61(95% CI:4.15 to 5.07,Z = 19.65,p < 0.01).4.No serious adverse reactions were found.Conclusion: After 1-3 weeks of treatment with alprostadil and ?-lipoic acid,the improvement of clinical symptoms and nerve conduction velocity was more obvious than that of the single drug group,and the safety was good.