Cymbalta (duloxetin) is a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of moderate to severe depression as well as periferal diabetic neuropathic pain in adults.
Shortterm studies on duloxetin (8 to 9 weeks) have demonstrated an efficacy in the treatment of depression better than placebo, and not worse than paroxetin and fluoxetin. The efficacy of the most optimistic studies can be estimated to a NNT value of 4-7 (remission after 8-9 weeks). Cymbalta’s ability to prevent longterm relapse corresponds to a NNT value of approximately 10.
A certain analgesic effect in the beginning of the treatment has been shown, though this effect doenst seem to be consistent. Apparently, the analgesic effect for diatebic neuropathic pain is comparable to gabapentin (NNT 4), and slightly lower than that of amitriptylin (NNT 2-3), but unfortunately, Cymbalta has not been clinically compared directly to neither of the obvious comparators, venlafaxin, TCA and gabapentin. Nausea is a frequently encountered adverse reaction, but in other respects the adverse reactions are similar to other antidepressants.
The dose for depression is 60 mg a day at a cost of nearly DKK 15, though those doses, which have been shown to be as efficacious as other SSRI’s, are 80 and 120 mg. Comparatively, the cheapest venlafaxine costs DKK 10.25-20.52 (75-150 mg), whereas paroxetine and fluoxetine costs approximately DKK 2.59 and 0.74 a day. General reimbursement is granted if prescribed for depression, but not for periferal diabetic neuropathic pain, for which the cost is DKK 14.71-29.42 a day, while other medicinal products of this type costs DKK 1.70-37.74 a day.
IRF still recommends the SSRI’s as a first-line treatment for depression, and subsequently other drugs can be chosen according to dose and hence price.
For periferal diabetic neuropathic pain TCA (tricyclic antidepressants) are the drugs of first choice, followed by gabapentine. Subsequently, pregabalin and SNRI can be chosen, as a daily dose of either one are more expensive. Until data are available, which compares Cymbalta to similar antidepressants or to medicinal products for neuropathic pain, the role of Cymbalta in the treatment of these diseases remains unclarified.
Cymbalta was marketed January 31, 2005 and has per August 2005 had its indication broadened for periferal diabetic neuropathic pain in adults.
Last modified: October 24th 2005