Benfotiamina: un derivado liposoluble de la vitamina B1 para el tratamiento de la polineuropatía diabética

Abstract

One in three patients with Diabetes Mellitus (DM) is affected by distal symmetric polyneuropathy (DSPN). This disorder of multifactorial etiology represents an important health problem given its association with the appearance of ulcers and amputations, the reduction of the quality of life and the increase in mortality. The current approach to the treatment of DSPN is based on prevention and rests on three fundamental pillars: a) Achieve early normoglycemia by also reducing cardiovascular risk factors, b) Identify and treat the pathogenic mechanisms that damage the peripheral nerve and c) Treatment and relief of symptoms. Increasing knowledge of the pathogenic mechanisms that damage the peripheral nerve has allowed the development of therapies currently called "disease modifying treatment" and that exert their effects despite the predominant hyperglycemic environment. Within this group of medicines we locate the antioxidant α-lipoic acid, actovegin and benfotiamine. In patients with DM it is common to find low concentrations of thiamine in plasma associated with increased clearance of this. Benfotiamine is a prodrug of thiamine with higher bioavailability and improves neuropathic symptoms, with high safety and good tolerance in patients. The inadequate response and undesirable side effects to conventional analgesic drugs and particularly those with action on the central nervous system in the treatment and relief of neuropathic pain, make this issue one of the most important problems in clinical practice. Based on the fact that the PNDS treatment is a decision that involves a multifactorial intervention that includes neuropathic factors, cardiovascular risk and the selection of the appropriate multimodal analgesic treatment, it is our interest to highlight the benefits of a therapy that can be integrated to the preventive and pathogenic treatment of this disorder.