Original Research

Weight Gain in Veterans Taking Duloxetine, Pregabalin, or Both for the Treatment of Neuropathy

Fed Pract. 2021 May;38(5):238-242 | 10.12788/fp.0111

Author(s):

Introduction: Peripheral neuropathy is a common condition with an estimated incidence of 3 million cases in the United States per year, with manifestations including weakness, numbness, burning or tingling sensations, and lingering pain. The burden of neuropathy may be greater among veterans due to the higher prevalence of type 2 diabetes mellitus (T2DM) and an aging population. Among the medications used to treat neuropathy are duloxetine and pregabalin. It has been observed at the Sioux Falls Veterans Affairs Health Care System (SFVAHCS) that veterans who are treated for neuropathy with duloxetine, pregabalin, or both, may experience significant weight gain after starting therapy. The purpose of this study was to evaluate the association of weight gain in veterans taking duloxetine, pregabalin, or both, for the treatment of neuropathy.

Methods: This was a retrospective, chart review study conducted at the SFVAHCS. The primary end point of this study was the change in body weight, expressed in pounds, after 12 to 18 months of treatment. The secondary end points of this study were the percent change in body weight; duration effect; dose effect, which evaluated weight gain at doses of duloxetine > 60 mg/d and pregabalin at doses > 300 mg/d; change in hemoglobin A _1c in patients with prediabetes and T2DM, and involvement in the Managing Overweight Veterans Everywhere (MOVE!) weight management program.

Results: The change in body weight after 12 to 18 months of treatment was -0.8 lb in the duloxetine group, +2.9 lb in the pregabalin group, and +5.5 lb in the pregabalin plus duloxetine group ( P = .12). The change in body weight after > 12 months of treatment was -0.88 lb in the duloxetine group, +3.6 lb in the pregabalin group, and +8.5 lb in the duloxetine plus pregabalin group ( P = .046). The change in body weight in patients who received increased doses of the study agents was -2.8 lb in the duloxetine group and +6.5 lb in the pregabalin group ( P = .047).

Conclusions: There was no significant difference in weight in veterans who took duloxetine, pregabalin, or both, for treatment of neuropathy after 12 to 18 months of therapy. However, there was a difference in weight gain among the 3 groups when therapy lasted > 12 months. The combination therapy of pregabalin and duloxetine was associated with the most amount of weight gain, followed by pregabalin alone. Monotherapy of duloxetine had minimal association with weight gain. In veterans who took increased doses of duloxetine or pregabalin, there was a difference in weight between the monotherapy groups, with pregabalin associated with weight gain and duloxetine associated with weight loss.

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References

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Neuropathy is the result of damage to the nervous system. This dysfunction generally occurs in peripheral nerves, which are the circuits that transmit signals to the brain and spinal cord. The peripheral nervous system is responsible for controlling motor and autonomic nerves and conduction of sensory information. Injury to the nervous system can lead to changes in nerve fiber sensitivity and malfunctioning of nerve stimuli pathways. Neuropathy may be a sequela of a wide variety of diseases, including diabetes mellitus (DM), autoimmune disorders, infections, and cancer. Also, neuropathy can be caused by medications, trauma, exposure to toxins, classified idiopathic.^1-5

Peripheral neuropathy is a common condition with an estimated incidence of > 3 million cases in the United States per year.⁴The burden of neuropathy may be greater among veterans, due to a higher prevalence of type 2 DM (T2DM) and an aging population. Manifestations of neuropathy include weakness, numbness, burning or tingling sensations, and lingering pain.^3,5This can lead to limited mobility and decreased quality of life. Neuropathy can be debilitating, but several medications can be used to alleviate symptoms—including duloxetine and pregabalin. The American Diabetes Association recommends either agent as initial treatment for neuropathic pain in patients with DM.² As with all medication use, the benefits and risks of treatment must be assessed prior to initiation of therapy.

The Centers for Disease Control and Prevention estimates > 70% of adults in the United States are overweight or obese.⁶ Excessive weight gain causes a higher risk of developing certain comorbidities, such as coronary artery disease, cerebrovascular accident, T2DM, and cancer, and all can lead to premature death. It is important to avoid excessive weight gain whenever possible, especially in patients already at a high risk for developing these diseases.

The correlation of weight gain in patients taking duloxetine, pregabalin, or both is not well studied. Duloxetine has the potential to cause weight gain or weight loss, with reports of > 1% incidence for either effect.⁷ Clinical significance of weight changes caused by duloxetine is uncertain.Pregabalin is more likely to cause weight gain, with a reported incidence between 2 and 14%.⁸ Weight gain may be associated with dose and duration; 1 study demonstrated an average weight gain of about 11 lb after 2 years of pregabalin treatment.⁸ The medical literature lacks information regarding weight gain associated with combination therapy of duloxetine and pregabalin. The objective of this study was to investigate the association of weight gain in veterans taking duloxetine, pregabalin, or both for the treatment of neuropathy.

Weight Gain in Veterans Taking Duloxetine, Pregabalin, or Both for the Treatment of Neuropathy

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