OBJECTIVES: Diabetic Neuropathy (DNeP) is a most common long-term micro vascular complication associated with the diabetes, it has high impact on persons health-related quality of life and substantial increase in socioeconomic costs. A Network Meta-analysis (NMA) was performed to assess the relative effectiveness and safety of pharmacological treatment used in management of diabetic neuropathy.

METHODS: A comprehensive data search was done in Medline (PubMed), Cochran and clinical trial.gov. Then we systematically reviewed 45 randomised clinical trials and included in the analysis according to the eligibility criteria by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and we used Random effect model frequentist approach for NMA, and we took proportion of subjects experienced 30% pain reduction as efficacy outcome and total withdrawal from trial as a safety outcome. We assessed risk of bias for included studies using revised Cochran Risk of Bias tool (RoB 2).

RESULTS: Overall 10511 individuals who assign to 11 active drugs were were recruited by 45 randomized clinical trials included in the multiple treatment comparison. Carbamazepine, Pregabalin/Duloxetine combination, Duloxetine high dose, Duloxetine 60mg, were showing significant grater efficacy than the placebo and OR; CI, 5.42 (2.11;13.95), 3.27 (1.71;6.27), 2.80 (1.43;5.46), 1.98 (1.29;3.04) respectively. Ranking order for safety was Oxcarbazepine, Venlafaxine, Pregabalin, Gabapentin, Capsaicin, Lacosamide, Duloxetine, Lamotrigine, and Placebo.

CONCLUSIONS: The findings of our NMA suggests that Lamotrigine and Carbamazepine were the best drugs with highest efficacy and safety. Gabapentin, Pregabalin high doses were more efficacious but shown less safer drugs.