Exp Clin Endocrinol Diabetes 2008; 116(10): 600-605
DOI: 10.1055/s-2008-1065351
Article

© Georg Thieme Verlag KG Stuttgart · New York

Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a Randomised, Double Blind, Placebo-controlled Clinical Study

H. Stracke 1 , W. Gaus 2 , U. Achenbach 3 , K. Federlin 1 , R.G. Bretzel 1
  • 1Medical Clinic und Policlinic III, University Hospital Giessen and Marburg, Location Giessen, Germany
  • 2Institute for Biometrics, University Ulm, Germany
  • 3Wörwag Pharma GmbH & Co. KG, Böblingen, Germany
Weitere Informationen

Publikationsverlauf

received 28.11.2007 first decision 08.01.2008

accepted 11.03.2008

Publikationsdatum:
13. Mai 2008 (online)

Abstract

Aim: Efficacy and safety of benfotiamine in treatment of diabetic polyneuropathy.

Methods: Double blind, placebo-controlled, phase-III-study. 181 patients were screened. 165 patients with symmetrical, distal diabetic polyneuropathy were randomised to one of three treatment groups entering the wash-out phase and 133/124 patients were analysed in the ITT/PP analysis: Benfotiamine 600 mg per day (n=47/43), benfotiamine 300 mg per day (n=45/42) or placebo (n=41/39).

Results: After 6 weeks of treatment, the primary outcome parameter NSS (Neuropathy Symptom Score) differed significantly between the treatment groups (p=0.033) in the PP (per protocol) population. In the ITT (intention to treat) population, the improvement of NSS was slightly above significance (p=0.055). The TSS (Total Symptom Score) showed no significant differences after 6 weeks of treatment. The improvement was more pronounced at the higher benfotiamine dose and increased with treatment duration. In the TSS, best results were obtained for the symptom “pain”. Treatment was well tolerated in all groups.

Conclusion: Benfotiamine may extend the treatment option for patients with diabetic polyneuropathy based on causal influence on impaired glucose metabolism. Further studies should confirm the positive experiences.

References

  • 1 Arora S, Lidor A, Abularrage CJ, Weiswasser JM, Nylen E, Kellicut D, Sidawy AN. Thiamine (vitamin B1) improves endothelium-dependent vasodilation in the presence of hyperglycemia.  Ann Vasc Surg. 2006;  20 ((5)) 653-658
  • 2 Bastyr  3rd  EJ, Price KL, Bril V. the MBBQ Study Group . Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy.  Clin Ther. 2005;  27 ((8)) 1278-1294
  • 3 Bolton WK, Cattran DC, Williams ME, Adler SG, Appel GB, Cartwright K, Foiles PG, Freedman BI, Raskin P, Ratner RE, Spinowitz BS, Whittier FC, Wuerth JP. ACTION I Investigator Group . Randomized trial of an inhibitor of formation of advanced glycation end products in diabetic nephropathy.  Am J Nephrol. 2004;  24 ((1)) 32-40
  • 4 Brownlee M. Biochemistry and molecular cell biology of diabetic complications.  Nature. 2001;  414 813-820
  • 5 Cellek S. Point of no return for nitrergic nerves in diabetes: a new insight into diabetic complications.  Curr Pharm Des. 2004;  10 ((29)) 3683-3695
  • 6 Freedman BI, Wuerth JP, Cartwright K, Bain RP, Dippe S, Hershon K, Mooradian AD, Spinowitz BS. Design and baseline characteristics for the aminoguanidine Clinical Trial in Overt Type 2 Diabetic Nephropathy (ACTION II).  Control Clin Trials. 1999;  20 ((5)) 493-510
  • 7 Hammes HP, Du X, Edelstein D, Taguchi T, Matsumura T, Ju Q, Lin J, Bierhaus A, Nawroth P, Hannak D, Neumaier M, Bergfeld R, Giardino I, Brownlee M. Benfotiamine blocks three major pathways of hyperglycaemic damage and prevents experimental diabetic retinopathy.  Nature Medicine. 2003;  9 ((3)) 294-299
  • 8 Haslbeck KM, Schleicher E, Bierhaus A, Nawroth P, Haslbeck M, Neundörfer B, Heuss D. The AGE/RAGE/NF-κB pathway may contribute to the pathogenesis of polyneuropathy in impaired glucose tolerance (IGT).  Exp Clin Endocrinol Diabetes. 2005;  113 288-291
  • 9 Haupt E, Ledermann H, Köpcke W. Benfotiamine in the treatment of diabetic polyneuropathy – a three-week randomized, controlled pilot study (BEDIP study).  Int J Clin Pharmacol Ther. 2005;  43 71-77
  • 10 Herholz H. Costs of diabetes: Complications are expensive.  Diabetes Stoffwechsel Herz. 2006;  ((Suppl 1)) 7-11
  • 11 Kasalova Z, Prazny M, Skrha J. Relationship between peripheral diabetic neuropathy and microvascular reactivity in patients with type 1 and type 2 diabetes mellitus.  Exp Clin Endocrinol Diabetes. 2006;  114 52-57
  • 12 Kihara M, Schmelzer JD, Poduslo JF, Curran GL, Nickander KK, Low PA. Aminoguanidine effects on nerve blood flow, vascular permeability, electrophysiology, and oxygen free radicals.  Proc Natl Acad Sci. 1991;  88 6107-6111
  • 13 Ledermann H, Wiedey KD. Behandlung der manifesten diabetischen Polyneuropathie. Therapeutische Wirkung des neurotropen Vitamin-B-Komplexes B1-B6-B12.  Therapiewoche. 1989;  39 1445-1449
  • 14 Schmidt J. Wirksamkeit von Benfotiamin bei diabetischer Neuropathie. Breite Anwendungsbeobachtung unterstreicht Praxisbenefit.  Kassenarzt. 2002;  14/15 40-43
  • 15 Stirban A, Negrean M, Stratmann B, Gawlowski T, Horstmann T, Gotting C, Kleesiek K, Mueller-Roesel M, Koschinsky T, Uribarri J, Vlassara H, Tschoepe D. Benfotiamine prevents macro- and microvascular endothelial dysfunction and oxidative stress following a meal rich in advanced glycation end products in individuals with type 2 diabetes.  Diabetes Care. 2006;  29 ((9)) 2064-2071
  • 16 Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy.  Exp Clin Endocrinol Diab. 1996;  104 311-316
  • 17 Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, Nuber A, Pozza G, Ward JD. EURODIAB IDDM Study Group . Prevalence of diabetic peripheral neuropathy and its relation to glycemic control and potential risk factors: the EURODIAB IDDM complications study.  Diabetologia. 1996;  39 1377-1384
  • 18 Thornalley PJ, Babaei-Jadidi R, Al Ali H, Rabbani N, Antonysunil A, Larkin J, Ahmed A, Rayman G, Bodmer CW. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease.  Diabetologia. 2007;  50 2164-2170
  • 19 Winkler G, Pal B, Nagybeganyi E, Öry I, Poochnavec M, Kempler P. Effectiveness of different benfotiamine dosage regimens in the treatment of painful diabetic neuropathy.  Drug Res. 1999;  49 ((I)) 220-224
  • 20 Woelk H, Lehrl S, Bitsch R, Koepcke W. Benfotiamine in treatment of alcoholic polyneuropathy: An 8 week randomized controlled study (BAP I study).  Alcohol Alcoholism. 1998;  33 631-638
  • 21 Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population.  Diabetologia. 1993;  36 150-154
  • 22 Ziegler D, Hanefeld M, Ruhnau KJ, Meissner HP, Lobisch M, Schutte K, Gries FA. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant α-lipoic acid.  Diabetologia. 1995;  38 1425-1433
  • 23 Ziegler D, Ametov A, Barinov A, Dyck PJ, Gurieva I, Low PA, Munzel U, Yakhno N, Raz I, Novosadova M, Maus J, Samigullin R. Oral treatment with α-lipoic acid improves symptomatic diabetic polyneuropathy. The SYDNEY 2 trial.  Diabetes Care. 2006;  29 2365-2370
  • 24 Ziegler D, Bierhaus A. Treatment of diabetic neuropathy.  Dtsch Med Wochenschr. 2007;  132 1043-1047

Correspondence

Prof. Dr. H. Stracke

University Hospital Giessen and Marburg GmbH

Medical Clinic and Policlinic III

Rodthohl 6

35392 Giessen

Germany

Telefon: +49/641/994 27 54

Fax: +49/641/994 27 69

eMail: Hilmar.Stracke@innere.med.uni-giessen.de

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