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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2017 September;176(9):439-45

DOI: 10.23736/S0393-3660.17.03445-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

L-acetyl carnitine in combination therapy for peripheral compression neuropathies

Leonardo SCARZELLA 1, 2

1 Unit of Neurology, Biella Hospital, Biella, Italy; 2 Ferrero Foundation, Alba, Cuneo, Italy


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BACKGROUND: This retrospective observational study in patients with chronic compression neuropathy of the lumbosacral or cervicobrachial district evaluated the efficacy of L-acetylcarnitine (LAC) and pregabalin (PRG), alone or in combination.
METHODS: Patients selected from a clinical database of Ospedale Evangelico Valdese were age 18 to 75 years with compressive neuropathy for ≥12 months treated for 8 weeks with LAC, PRG or their combination. Pain (10-point VAS) and neurosensory symptoms (DN4 Questionnaire) were used to assess efficacy at baseline, weeks 2, 4 and 8 during treatment. After 8 weeks of treatment, patients were observed off therapy for 8 additional weeks, to determine relapse rates and time to first relapse.
RESULTS: Eighty-one patients meeting inclusion criteria were divided into three homogeneous arms: 27 had received LAC 500 mg BID; 29 had received standard-dosage PRG 150 mg TID; 25 had received the combination of LAC 500 mg BID plus low-dosage PRG 150 mg/day (ld PRG). Combination treatment was significantly more effective than monotherapy: vs. standard-dose PRG (pain score improvement 12.8%, DN4 22.0%; both P<0.01); vs. LAC (pain score improvement 13.8%, DN4 22.2%; both P<0.01). PRG induced remission more rapidly than LAC; effects were similar at 8 weeks. Combination therapy provided fewer relapses (10.5% vs. 43.7%) and longer time to first relapse (7 weeks vs. 3 weeks). There were fewer drop-outs in the combination therapy group.
CONCLUSIONS: Combination therapy LAC (500 mg BID) plus pregabalin (150 mg/day) is effective and safe in patients with peripheral compression neuropathy. The complementary mechanisms of action allow reduction of the pregabalin dosage, while providing superior efficacy and tolerability.


KEY WORDS: Acetylcarnitine - Pregabalin - Combined modality therapy - Pain

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