Efficacy and tolerability of mirogabalin, pregabalin, duloxetine, and placebo in patients with type 2 diabetes mellitus and painful diabetic peripheral neuropathy: A network meta-analysis
Authors' conclusion
Within the available short-term evidence network, duloxetine demonstrated the most consistent analgesic efficacy and a more favorable metabolic safety profile than the α2δ ligands evaluated.
Study context
- Population
- Adults with T2D and painful diabetic peripheral neuropathy; mean age 57.7 years, HbA1c 7.6%, moderate baseline pain
- Participants
- 4,542 adults12 RCTs
- Comparison
- Mirogabalin, pregabalin and duloxetine vs placebo
- Outcome
- Pain reduction
Methodological detailsfrequentist network meta-analysis, GRADE/CINeMA certainty assessment
- Frequentist network meta-analysis
- GRADE/CINeMA certainty assessment
Pooled result
As reported in the abstract
Each group vs placeboSMD (95% CI)
Duloxetine 120 mgGRADE: high
−0.60(−0.91 to −0.28)
Mirogabalin 30 mg
−0.39(−0.59 to −0.19)
Pregabalinflexible dosing
−0.21(−0.42 to −0.01)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| >50% responderMirogabalin 30 mgvs Placebo | 2.13 (1.18–3.85) | |
| 0.20.5125Odds ratio (log scale) |
>50% responder
- Mirogabalin 30 mg alone achieved a significant >50% responder advantage
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Adverse effectsPregabalin 600 mgvs Placebo | 5.89 (2.00–17.33) | |
| 0.050.21520Odds ratio (log scale) |
Adverse effects
- Weight gain and edema elevated with both α2δ ligands; somnolence across agents
Original publication
Efficacy and tolerability of mirogabalin, pregabalin, duloxetine, and placebo in patients with type 2 diabetes mellitus and painful diabetic peripheral neuropathy: A network meta-analysis. Diabetes Res Clin Pract. Published 6 August 2026. doi:10.
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