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Di Stefano G, Di Lionardo A, Galosi E, et al. Acetyl-L-carnitine in painful peripheral neuropathy: a systematic review. J Pain Res. 2019 Apr 26;12:1341-1351. doi: 10.2147/JPR.S190231. eCollection 2019. (Systematic review)
Abstract

Acetyl-L-carnitine (ALC) has shown a neuroprotective effect in patients with peripheral neuropathies of different etiologies. Preclinical studies demonstrated a central anti-nociceptive action, both in neuropathic and nociceptive pain models. The present review aims to provide the knowledge on the efficacy of ALC in patients with painful peripheral neuropathy, based on the evidence. Consistent with the PRISMA statement, authors searched PubMed, Embase and the Cochrane Database of Systematic Reviews for relevant papers, including those issued before April 2018. Two authors independently selected studies for inclusion and data extraction: only trials including patients with a diagnosis of peripheral neuropathy and involving at least 10 patients were considered for the purposes of this review. Fourteen clinical trials were revised, to provide the level of evidence for neuropathy. To assess the global efficacy of ALC in painful peripheral neuropathy, a meta-analysis of four randomized controlled trials was performed. Mean difference in pain reduction as measured on a 10-cm VAS, and 95% CIs were used for pooling continuous data from each trial. Four randomized controlled trials tested ALC in patients with neuropathy secondary to diabetes and to antiretroviral therapy for HIV. Compared to placebo, ALC produced a significant pain reduction equal to 20.2% (95% CI: 8.3%-32.1%, P<0.0001) with respect to baseline. Clinical trials also showed beneficial effects on nerve conduction parameters and nerve fiber regeneration, with a good safety profile. These data indicate that ALC provides an effective and safe treatment in patients with painful peripheral neuropathy. We recommend further studies to assess the optimal dose and duration of the therapeutic effect (also after treatment withdrawal).

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Physician 5 / 7
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Physician rater

This is a very interesting review. Only less than half neuropathic pain patients can achieve good pain control. Novel therapeutic agents should be considered as an adjuvant and combination therapy with the established agent (gabapentin. pregabalin, SNRI, and TCA). The use of systematic ways in finding and appraising articles are the strength of this review. This review showed promising result. This review showed that Acetyl L CarnitineALC produced a significant pain reduction equal to 20.2% (95% CI: 8.3%-32.1%, P&lt;0.0001) with respect to baseline. Clinical trials also showed beneficial effects on nerve conduction parameters and nerve fiber regeneration, with a good safety profile. These data indicate that ALC provides an effective and safe treatment in patients with painful peripheral neuropathy. Further trials to assess the optimal dose and duration of the therapeutic effect are warranted.

Physician rater

There is modest pain relief from carnitine in meta-analysis. Several authors note financial relationship with Sigma-Tau, which appears to be a maker of carnitine.
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