Acetyl-L-Carnitine for diabetic neuropathy

[Lisa O]

Acetyl-L-carnitine lessens pain associated with diabetic neuropathy

Last Updated: 2005-01-14 17:11:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with diabetic neuropathic pain may find significant relief with acetyl-L-carnitine (ALC) provided the treatment is started early, according to a re-analysis of data from two large placebo-controlled trials.

"ALC is not currently approved for this indication in the US, but it is used widely for painful neuropathy in patients with diabetes and AIDS in Europe," Dr. Anders A. F. Sima from Wayne State University School of Medicine in Detroit, noted in a telephone interview with Reuters Health.

In the original two trials -- one conducted in Europe and the other in the US and Canada -- ALC (500 or 1000 mg/day t.i.d. for 52 weeks) had no significant effect on nerve conduction velocity -- the primary efficacy endpoint of the trials -- in patients with diabetic polyneuropathy.

But in a reanalysis of data on 93% of study subjects (n=1257), Dr. Sima's group discovered that ALC at the higher dose significantly alleviated pain in a subgroup of patients (27%) who reported pain as "the most bothersome symptom" at baseline.

"Pain is very common in patients with diabetic peripheral nerve diseases, occurring in 30% to 35% of patients," Dr. Sima said. "It is usually extremely bothersome for the patients and in extreme cases drives them to suicide. We found that ALC has a significant effect on pain."

The greatest reductions in pain were seen in patients with diabetic neuropathy of short duration. "This is an axiom that goes for any of these treatments in chronic disorders like this, 'the earlier you can start treatment the better,'" Dr. Sima said, adding that ALC is "very tolerable."

ALC treatment was also associated with improvements in nerve fiber regeneration and vibratory perception.

Mirroring the original studies, ALC had no effect on nerve conduction velocities, suggesting that this is not a good endpoint for these types of trials, the team notes in the January issue of Diabetes Care.

Dr. Sima said his team is currently working with the US Food and Drug Administration to get ALC formally approved for painful diabetic neuropathy.

Diabetes Care 2005;28:96-101.

I wonder if it would work as well on chemotherapy induced neuropathy?