Memantine efficacy in chemotherapy-induced peripheral neuropathy: double-blind placebo-controlled randomised clinical trial

Clinical Snapshot

Key Findings

• P Value: p<0.001 for both outcome measures

• Effect Size: Not reported in abstract

• Primary Outcome: Significant improvement in neuropathy (tuning fork test) and pain scores (McGill Pain Questionnaire)

• Nnt Or Sensitivity: Not calculable from available data

• Confidence Interval: Not reported

Clinical Application

Memantine is orally administered, well-tolerated, and requires standard titration protocol Memantine is PBS-listed for dementia; off-label use for CIPN would require specialist consideration and patient consent Adult cancer patients with established CIPN from various chemotherapeutic agents

Abstract

BACKGROUND AND AIMS: Chemotherapy-induced peripheral neuropathy (CIPN) is a detrimental side effect of chemotherapeutic agents. If left untreated, CIPN can persist for several years following the chemotherapy. CIPN management may enhance the quality of life of the affected patients. This study evaluated the efficacy of memantine, an antagonist of N-methyl-D-aspartate, in CIPN management. METHODS: This double-blinded randomised clinical trial was performed on 176 individuals with CIPN. Patients were randomised to either the memantine or placebo groups (88 in each). The memantine group received a single daily dose of 5 mg for the initial 3 days. Subsequently, the dosage was increased to 20 mg per day, with 5 mg increments every 3 days. The placebo group received tablets of equal shape and size. All individuals received medications for 8 weeks. The McGill pain questionnaire and tuning fork test were used to evaluate the severity of neuropathic pain in patients, both at baseline and after the intervention ended. RESULTS: Based on tuning fork test results, significant improvement in neuropathy was observed among patients who received memantine compared with those who received placebo (p<0.001 vs 0.665). McGill pain questionnaire score revealed a significant difference between memantine and placebo groups (p<0.001 for both groups). This difference was also significant after performing intention-to-treat analysis. Moreover, a higher proportion of patients in the memantine group achieved minimal clinically important difference. CONCLUSION: The use of memantine mitigated the CIPN intensity. Thus, it appears that memantine is a promising option for the management of patients experiencing CIPN.

References

1. 1.Esmaili, N., Beheshtirouy, S., Sanaat, Z., Shaseb, E., Sarbakhsh, P., & Ghaffary, S. (2024). Memantine efficacy in chemotherapy-induced peripheral neuropathy: double-blind placebo-controlled randomised clinical trial. BMJ Supportive & Palliative Care. https://doi.org/10.1136/spcare-2024-005348