Talk:Duloxetine

Use of Statistics

The article states that "Five people . . . committed suicide while Eli Lilly was conducting preliminary trials." But five out of how many total? The linked NY Times article says 9,000, but I myself don't know enough about this topic to add the information myself.

--Skb8721 18:07, 24 September 2006 (UTC)

Um, yeah. That's an incredibly bogus statement to just put into an article. And just because the NYT is also crap at statistics doesn't make it encyclopedic information. Five out of how many? How many in the control group? Reference to the study itself? Not present. I've removed the line from the article in the meantime; it was:

Five people, including a 19-year old college student, committed suicide while Eli Lilly was conducting preliminary trials. (ref)G. Harris (2004): The New York Times

I appreciate whoever put it there did so thinking it was useful information, but it doesn't actually tell the reader a damn thing - stated as is, it's scaremongering. If there's a real problem that's encyclopedic information, it needs more than one piece of newspaper bad science - David Gerard 18:26, 8 October 2006 (UTC)

Side Effects

The Literate Engineer 21:50, 19 February 2006 (UTC)

What are the side effects of taking Duloxetine?

---

Although Duloxetine (trade name: Cymbalta) is a serotonin and norepinephrine reuptake inhibitor, while Buproprion (trade names: Wellbutrin and Xyban) is a dopamine reuptake inhibitor, I find their effects very similar. Your Mileage May Vary. Perhaps they seem similar to me because they are the only treatments for depression which are effective for me (and I've tried nearly every other medication available).

Cymbalta tends to make one feel energetic, but also increase anxiety. During the first two to three days when I begin taking it, I experience "psychedelic" side-effects such as exaggeration of perspective; this would be familiar to anyone who has taken LSD. However, these effects are mild, and either goes away very quickly, or perhaps one simply adapts to it.

The most noticeable side-effects, for me, are dry mouth and difficulty sleeping. I get relief from dry mouth by chewing gum and using Biotene mouthwash. For sleep, I take amitriptyline (which is also indicated for fibromyalgia, a chronic muscle disorder I have). If that is not sufficient, I also take Trazodone. These are both tricyclic antidepressants. I take much smaller doses than would someone taking them for psychoactive effect to relieve depression. (Tricyclic antidepressants have become unpopular. At sufficient doses to treat depression, their side effects are difficult to tolerate.)

What little relief I've had from the popular SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Zoloft and Luvox, typically it takes a month or more to be felt. Whereas with Cymbalta and Wellbutrin, I usually feel significantly less depressed within a few days. Unfortunately, during periods of extremely severe depression, I find that higher doses of these medications do not help, but merely increase the severity of the side-effects. When that happens, my best strategy is to focus on the feelings or life events which are causing the depression. (That's something I should already be doing. Drugs are not a panacea. But in my case, sometimes I reach a point where to take more drugs is no longer helpful.)

A common problem with antidepressants is that they all have side effects which are distressing to greater or lesser degrees, depending on the individual's specific response to the drug, and also which side effects one finds more tolerable than others. The side-effects begin as soon as you start taking the medication, while the beneficial effects (reducing or stopping depression) take longer. This makes it difficult to remain patient and keep taking the drug. Especially for someone whose depression (as it usually does) alters their thinking in such a way as to make them feel there is little hope.

All of these medications affect different people in unique ways. If you are seeking pharmaceutical treatment for depression, try to wait about two months to be sure whether or not a new medication is working. If it's not, try something different. Of course, this should be done under the supervision of a psychiatrist; MDs in other specialties are rarely well-informed about antidepressants. Also: pharmacists are often better sources of information on medications than doctors.

Good source of info on medication effects and side-effects: http://www.rxlist.com/ drone5 00:04, 12 December 2005 (UTC)

Impartial links?

Should there the link to the manufacturer's website be there? Surely it's promotional? Also, outside North America direct-to-consumer advertising of prescription-only drugs is illegal.

In the same vane, should the manufacturer's logo be so prominently displayed? I understand that their marketing of duloxetine makes it most visible to the public, but wikipedia isn't meant to be a marketing tool. Let's discuss the chemical and move the corporate information to a section later in the article. Alvis 06:09, 23 April 2006 (UTC)

And anyway, the article isn't about Cymbalta, it's about duloxetine. -Etoile 21:20, 20 May 2006 (UTC)

i had the misfortune of taking this... it took a week of almost continuous morphine to keep my migraines in check. i think it will be pulled from the market -Lieutenant Colonel Frank Slade 07:41, 17 June 2006 (UTC)

"Long-term side-effects seen in these trials did not vary from the original approval studies." <-- ?? is that really needed? doesn't flow in my mind, but I'm not removing it. -- Lieutenant Colonel Frank Slade 13:57, 2 July 2006 (UTC)

IMHO, links to the manufacturer's website should be included, though a display of the company's logo should not, and the generic name clearly identified [currently the Wikipedia page meets these suggestions]. On the manufacturer's site should appear the prescribing information and, among other things, all the incidences of side effects that occurred during the clinical trials that were reported to the FDA. Unfortunately, such information is not always easy to interpret; although the number of occurrences of a particular side effect are reported vs the number of occurrences for a placebo, there is no assurance that the side effect was a response to the drug, only that it occurred to a patient taking the drug. If the incidence is high relative to the placebo, then there is a greater probability that that it is a common side effect. On the other hand, because some individuals respond differently (for many possible reasons), a low incidence of a side effect may still be a response to the drug. In any case, the FDA requires that the manufacturer report all this information and it can be valuable to the patient. The average user should of course be aware that the promotional blurbs on the manufacturer's site should be weighed against other treatment options. I would say consult your doctor, but I have often seen the same promotional promotional information in pamphlets inside the doctor's office. Caveat Emptor! After you visit your doctor, talk the pharmacist, sometimes they know more than the doctor. Janopus (talk) 18:25, 13 January 2009 (UTC)

NPOV

[[ == This article sounds like an advert written by the drug company itself... There are no side effects, No study texts A link to the manofacturer website And the technical language which usually appears in this kind of Advert. ==]]

I don't know how much this will help, but there are some particularly deleterious side effects. If you miss a dose, it hits you like a sledgehammer...you'll have headaches diarrhea, constant sweating, and a general feeling of malaise and weakness. I believe that this is due to withdrawal from the norepinephrine, as it's half-life within the body is relatively short as compared to serotonin. I had a brief discussion with my doc about this, and he esentially confirmed it, but this is just heresay evidence. Take it for what you choose 72.44.0.76 23:02, 20 September 2006 (UTC)

Suicide as a side-effect?

Stories about Cymbalta/Duloxetine I do not know if this story is true or not!! But I think for the sake of discussion it should be considered. I came across this article because I was researching the medicine my wife was prescribed.

It is true that some anti-depression drugs have this suicide side effect according to some traditional Chinese medicine doctors, such as Hai-Sha Ni --Leo 05:35, 12 December 2006 (UTC)

A side effect of *depression* is suicide. It would logically follow that people taking anti-depressants would in some cases commit suicide. --204.210.233.175 20:49, 11 January 2007 (UTC)

Well, the most common explanation for the increased risk of suicide is that (rather than directly increasing thoughts of suicide) anti-depressants have an immediate effect upon your energy, which enables you to actually go through with the thoughts - the anti-depressant affect takes a bit longer. This is the explanation I've gotten from the most psychiatrists, at least. -Elizabennet | talk 19:55, 7 April 2007 (UTC)

I wonder if there is any actual evidence for that explanation. If there is, this would be something to include in the article. Neitherday 22:15, 7 April 2007 (UTC)

Vertigo

I personally take this medicine and have encountered abrupt vertigo as a side effect. I also searched online and found this to be mentioned by many patients. I cannot, however, find a research document listing this as a side effect. Has anyone else found anything? Smeggysmeg 06:19, 22 February 2007 (UTC)

According to Eli-Lilly, vertigo is listed as a "frequent" side effect. Frequent is defined as occuring in at least 1/100. Others defined as frequent are: hot flush, anorgasmia/orgasm abnormal, dysguesia, lethargy, parasthesia/hypoesthesia, weight increase, chills/rigors, and palpitations. This in not a comprehensive list. Tunafizzle (talk) 07:41, 17 August 2008 (UTC)

I just started this med and my head is spinning. I've been taking Zoloft for some time; my dr. said I would probably feel the "positive" effects of Cymbalta more quickly because of that. Also, since I started taking it (less than a week now), I am having a big bad flare up of my fibromyalgia pain. THAT could be a coincidence - it's hard to tell with fibro. The dr. is hoping that the Cymbalta can take the place of not only the Zoloft but the pain meds I'm on as well - Tramadol and Neurontin. In addition to the fibro, he's treating me for an obnoxious OCD, where I am picking my scalp and pulling my hair out. (That sounds so awful, but I know there are other people who do it.)Meowfur29 (talk) 15:52, 15 September 2008 (UTC)Meowfur29

I have recently started this med also. I took one 30 mg capsule a few hours ago and now I feel nervous and (uncomfortably) stimulated.--Metalhead94 (talk) 19:46, 25 October 2008 (UTC)

"Controversy" section considered harmful

That entire section reads like four paragraphs of disguised CCHR propaganda and needs to be drastically rewritten. Totally inappropriate for Wikipedia. Haikupoet 07:26, 29 December 2006 (UTC)

Agreed: This article needs a lot of cleaning up and editing. It is totally sensational. --Joyfulpotato 02:34, 26 January 2007 (UTC)

A certain [user 67.82.232.151|user:67.82.232.151] has a clear bias against the Eli Lilly Corporation, and has single-handedly added the vast majority of the current 'Controversy' section. Since one guy with a grudge has had such a huge effect on this page, I’m adding a POV tag. I know nothing about the industry myself, but until someone can verify this information we should let people know what’s what.

Here are some of his edits to the Eli Lilly page:

Eli Lilly has been known to engage in withholding internal information on medications, including Prozac, Thimerosal and Zyprexa in order to downplay side effects and adverse reactions in order to boost profits. [1]

Consequently, many critics claim that the FDA approval of duloxetine for Major Depressive Disorder (MDD) and diabetic neuropathy is irresponsible and intellectually dishonest, and is a case illustration of the agency's failure to prevent harmful drugs from being marketed in the name of big profits. [2]

In one of the only three cases to ever go to trial for SSRI indication in suicide, Eli Lilly was caught corrupting the judicial process by making a deal with the plaintiff's attorney to throw the case, in part by not disclosing damaging evidence to the jury. [3]

Over the last decade, the company spent millions of dollars lobbying Congress in hopes of extending its patent on Prozac and some lawmakers even attempted to insert last-minute provisions to omnibus spending bills to grant the company’s wish. Generic drugmakers prevailed, handing Eli Lilly one of its few legislative losses in recent memory. The company, which favors Republicans over Democrats with its contributions… [4]

This same user also started the ‘Controversy’ statement on the Duloxetine page, containing the following outsourced and obviously biased statements:

In the 1980s, [Eli] Lilly waged a successful campaign to get fluoxetine, brand name Prozac, through the FDA even though not a single study submitted to the agency showed the drug to be effective for depression when taken alone. …not only targets serotonin, it also impacts another important neurochemical, norepinephrine. This flatly contradicts the ‘serotonin/good, norepinephrine/bad’ story that launched the SSRI revolution that [Eli] Lilly started with fluoxetine. [5]

He started a ‘Legal’ section on the Olanzapine page with this:

…documents given to The Times by a lawyer representing mentally ill patients, show that [Eli] Lilly executives kept important information from doctors about Zyprexa’s links to obesity and its tendency to raise blood sugar — both known risk factors for diabetes. [6]

He adds this unsourced statement to the SSRI Discontinuation Syndrome page:

Data obtained from 9 clinical trials assessing the efficacy and safety of duloxetine in the treatment of major depressive disorder (MDD) by Lilly Research found that patients with discontinuation-emergent adverse events (DEAEs) were reported by 44.3% of duloxetine patients… No follow up was published by [Eli] Lilly stating the duration of DEAE's longer than one week ultimately persisted for. [7]

--70.17.209.58 09:02, 22 March 2007 (UTC)

Controversy neutrality

Is there anything specifically in the current version of the controversy that is disputed as POV? If not the template should be removed. Neitherday 14:45, 28 April 2007 (UTC)

Much of the text was originally written by someone with an obvious bias towards Eli Lilly, but I think most of the text is OK now, although it's not clear to me why the financial section is included in controversy. I am not totally comfortable with removing the template yet, but I am putting the financial in a separate section. 66.75.247.88 08:10, 30 April 2007 (UTC)

I moved the POV template to the financial section, since that is where the problem is. Neitherday 14:06, 30 April 2007 (UTC)

. —Preceding unsigned comment added by 72.95.16.67 (talk) 04:50, 9 November 2007 (UTC)

Salt form

The hydrochloride part of the molecule is not the pharmacologically active portion of the molecule, so I've removed it from the intro to the article (as per WikiProject Pharmacology standards). Fuzzform 23:19, 28 May 2007 (UTC)

The most important section

As is typical for articles of this kind written in an adversarial tone, the article lacks a sensible paragraph that lists the positive trials and the indications for which it has been succesfully approved. This doesn't just belong in "history". Doctors would normally only prescribe a medication if there have been studies showing a benefit. I have certainly seen duloxetine used for chronic pain - if there have been studies these need to be mentioned. JFW | T@lk 06:24, 14 May 2008 (UTC)

Doctors, being merely humans, often prescribe medications under the influence of company salesmen and do not usually read critical reviews in French. On the balance, duloxetine does not appear to be a great medication. Thus it may be argued that the most important part here is the side effects part. Paul Gene (talk) 10:54, 14 May 2008 (UTC)

So far, all I have seen from Prescrire Int is gloomily negative reviews, often quoting data that is not otherwise accessible and therefore not open to verification.

"On the balance", I submit, reflects your conclusions after reading this article. Or have you other sources that we ought to know about? JFW | T@lk 14:12, 14 May 2008 (UTC)

Before anyone asks, I can't think of a single instance when I prescribed this drug personally, nor have I been bowled over by drug company representatives or dazzled by clinical trials. It's just that every time I review this article I am astounded by the hostility, assumption of bad faith and overemphasis on so-called side effects (every SSRI can cause hyponatremia, why put so much stress on a single report here?) JFW | T@lk 14:32, 14 May 2008 (UTC)

There are two major problems with duloxetine - hepatotoxicity at higher doses and suicides of healthy volunteers. They are the main reasons why Lilly's application for SUI indication failed. Paul Gene (talk) 18:33, 14 May 2008 (UTC)

In none of the SUI trials was there any report of hepatotoxicity. How many events were there - or rather what is the source that this was the reason for failing the application? And do you have any idea why the Europeans were not worried by this? JFW | T@lk 11:54, 15 May 2008 (UTC)

CT Registry ID# 6192. ~ 600 patients with SUI/MUI exposed to 80 mg duloxetine for ~250 days.

Elevations above the upper limit of normal for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase values were observed on at least one occasion of 14.8%, 9.4%, and 6.8% of subjects, respectively. TEAEs related to hepatic analytes were reported as follows: 4 for liver function test abnormal, 3 for hepatic enzymes increased, 2 for alkaline phosphatase increased, and 1 for ALT increased. Overall, 4 subjects discontinued from the study from liver function test abnormal, 2 subjects discontinued due to hepatic enzymes increased, and 1 subject discontinued due to ALT increased. Seven subjects reported the TEAE of CPK increased; 3 of whom discontinued from the study. (A subject is considered at-risk for a given laboratory analyte and abnormality category (Low, High, or Positive) if there was at least one baseline measurement for that laboratory analyte and that category of abnormality was not present for any baseline measurement. An abnormal postbaseline laboratory result is considered treatment-emergent if the subject is at-risk for that abnormality and the abnormality was not present for any baseline laboratory assessment.) And are not French - Europeans? Paul Gene (talk) 16:24, 15 May 2008 (UTC)

I am returning the Prescrire-based summation of risks and benefits of duloxetine into the lead - that is exactly what the lead should have. A personal dislike of Prescrire cannot be the basis of removal. Paul Gene (talk) 10:44, 15 May 2008 (UTC)

I have given additional arguments, which you have not addressed. This journal is certainly not the final word on pharmacotherapeutics. JFW | T@lk 11:54, 15 May 2008 (UTC)

Are not suicides of healthy volunteers sufficient? If not, I also given you the data on toxicity above. Prescrire is not a final word, but it is independent; and some well-known people write for it. Paul Gene (talk) 16:31, 15 May 2008 (UTC)

Duloxetine Pharmacodynamics

I attempted to edit the following information:

"When serotonin and norepinephrine are released from nerve cells (neurons) in the brain they are reabsorbed into the nerve cells through reuptake. Duloxetine works by preventing serotonin, norepinephrine, and to a lesser extent dopamine from being reabsorbed into the nerve cells in the brain, specifically on the 5-HT and NE and D2 receptors respectively."

To this:

"After serotonin and norepinephrine have been released from neurons into the synapse, they are reabsorbed back into the presynaptic neurons through reuptake by transporter proteins. Duloxetine works by binding to and inhibiting the transporter proteins for serotonin (SERT), norepinephrine (NET), and to a lesser extent, dopamine (DAT), thus preventing reuptake, and allowing the neurotransmitter to remain longer in the synapse. This results in increased stimulation of the postsynaptic neuron."

Doesn't seem to have updated correctly, but that might just be a problem on my end. The original version was nonsense. Duloxetine is not known to bind to any neurotransmitter receptors, only reuptake proteins. From the prescribing information (available at http://pi.lilly.com/us/cymbalta-pi.pdf):

"Preclinical studies have shown that duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors in vitro."

If someone thinks its necessary, I can probably edit this section to be more accessible to a general audience, but I figure it's much better to have accurate and inaccessible information than basic information that's just plain wrong. —Preceding unsigned comment added by 131.247.152.4 (talk) 06:47, 21 May 2008 (UTC)

Paul gene (talk · contribs) removed it. I'm not sure whether it should have been removed, but I had previously tagged it with {{fact}} because such wide-ranging claims on method of action need a solid reference. Is this pharmacodynamic profile inferred from its effects, or have there being neurochemical studies that confirm its properties? If such a reference can be provided, I'm sure that we can return your contribution. JFW | T@lk 11:29, 21 May 2008 (UTC)

Controversial claim in first paragraph

The first paragraph of this article contains two statements that represent opinions rather than facts. That is, even though these statements cite articles from scientific journals, they clearly hold a bias against the use of this drug.

Duloxetine (brand names Cymbalta, Yentreve) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used for major depressive disorder (MDD), generalized anxiety disorder (GAD), pain related to diabetic neuropathy and fibromyalgia and in some countries for stress urinary incontinence (SUI). It is manufactured and marketed by Eli Lilly. Large number of side effects occurring during duloxetine treatment and lack of clear advantage over existing medications prompted critical reviews concluding that duloxetine "should not be used" for stress urinary incontinence[1] and "currently has no place in the treatment of depression or diabetic neuropathy" as well.[2][3]

I contest the following statements as biased:

The stated "lack of clear advantage over existing medications" surely is disputable in the psychiatric/pharmaceutical community. If doctors are prescribing this drug, they obviously have confidence in its efficacy.

The statement that the drug "should not be used" for urinary stress incontinence may represent an opinion rather than a general fact. Again, if this drug is officially designed or prescribed for this condition, it indicates that at least some portion of the professional community have confidence in Cymbalta's efficacay for this condition.

The statement that Cymbalta "currently has no place in the treatment of depression or diabetic neuropathy" is inappropriate here. This again represents an opinion held by the author of this particular article.

I am fairly new to Wikipedia and do not know how this dispute should be resolved. Should this section be tagged as biased? Or should one of us just delete/change it? The statements should perhaps be moved to a controversies/side effects portion of this article.

--Matthaller (talk) 21:25, 7 September 2008 (UTC)

With reference to previous discussions, I too agree that the opening paragraph (as well as other sections of the article) is quite one-sided. I would suggest that you try to find different sources to complement those presently being cited, and BOLDly improving the intro. If you are reverted (which is possible), discuss the disagreement on this talk page and try to reach consensus (WP:BRD). Let me know if you need any assistance. JFW | T@lk 21:41, 7 September 2008 (UTC)

The statements are citations from independent reviews, which are quoted closely to the original so you should not remove them. If you feel that they present the medication in too negative a light, you can add references to the positive reviews. That will easily fix the problem. Also see the discussion above in Talk:Duloxetine#The_most_important_section. Paul Gene (talk) 21:47, 7 September 2008 (UTC)

I have read the above posts. Though these independent reviews Paul gene has cited from Prescrire Int and Drug Ther Bull represent an opinion rather than consensus, they certainly should be cited and quoted in this Wikipedia article. However, it is unjustifiable to quote these opinions at length in the introductory paragraph. To resolve this dispute I propose that we make the following changes:

1) State in the introductory paragraph that "like all antidepressants, side effects of duloxetine should be weighed against its potential benefits."

2) In the intro paragraph add citations to four articles supporting the efficacy of duloxetine.

3) Retain the citations to the three papers in the intro paragraph from Prescrire Int and Drug Ther Bull that Paul gene has cited, but remove the quotations from these articles.

4) Move these quotations removed from the intro paragraph to a new section of the article labeled "Criticism of duloxetine" or something similar.

The three of us (and anyone else that wants to participate) can surely come to a resolution that results in a comprehensive and clear article, and that does not marginalize any particular viewpoint. Before I make the changes I have described above, I want to see how Paul gene and JFW feel about this. There's no point in getting into an editing/reverting war here. --Matthaller (talk) 16:52, 20 September 2008 (UTC)

I would just like to add that the first part of this article is the worst I have ever seen in terms of bias. It's an opinion piece against the drug disguised with a few questionable, unduly-weighted, cherry-picked facts. Matthaller has some excellent suggestions for fixing it; I second them. I would probably even go further in pulling it back toward neutrality. I was really surprised when I read the top part of the article - I've never run across this kind of thing before despite using Wikipedia a lot. -- (Anon), 22:57, 23 October 2008 (PST) —Preceding unsigned comment added by 66.241.81.202 (talk)

There is no bias in the lead part. Prescrire is a French journal known for its common-sense critical reviews. Drug and Therapeutics Bulletin is a part of the respected BMJ (British Journal of Medicine) group, and its stated purpose is: "DTB's aim is to provide informed and unbiased information on medical conditions, medicines and other treatments to enable people to make informed choices. True to this objective, DTB has always been wholly independent of the pharmaceutical industry, Government and regulatory authorities. DTB is also free of advertising and other forms of commercial sponsorship." (see http://dtb.bmj.com/info/independence.dtl).

To the contrary, it can be argued that many (although not all) positive reviews and publications have been sponsored by Lilly or Shionogy and therefore are biased.

Weighing drug benefits vs risks is by necessity a matter of opinion. The critical reviews in respected journals reflect an opinion of a significant part of medical community. For that reason both positive and negative views on the balance of benefits and risks for duloxetine should be presented. 71.244.121.113 (talk) 00:43, 1 February 2009 (UTC)

Bandolier

For DPN and fibromyalgia, there is fairly good data that duloxetine is effective. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Chronrev/Other/duloxetine.html JFW | T@lk 23:53, 3 November 2008 (UTC)

Duloxetine vs pelvic floor exercise + bladder training

The current chapter on SUI (duloxetine#stress urinary incontinence) selected only favorable for duloxetine conclusions of University of Minnesota analysis (PMID 18268288). It skips over the unfavorable comparison of duloxetine with other drugs and non-pharmacological therapies. The whole story must be presented.

Currently, duloxetine#stress urinary incontinence states: "...concluded that duloxetine did not lead to cure of stress urinary incontinence in the vast majority of people, but that episodes of incontinence were reduced by about 50%. This was associated with an improvement in quality of life measurements. Mild side-effects were common, and about a fifth had to discontinue the medication because of poor tolerance." That is selective reporting.

The abstract of the study (PMID 18268288) points out: "Compared with regular care, pelvic floor muscle training plus bladder training resolved urinary incontinence (pooled risk difference, 0.13 [95% CI, 0.07 to 0.20]). Pelvic floor muscle training alone resolved or improved urinary incontinence compared with regular care, although the effect size was inconsistent across studies. Oxybutynin or tolterodine resolved urinary incontinence compared with placebo (pooled risk difference, 0.18 [CI, 0.13 to 0.22]). Duloxetine compared with placebo improved (pooled risk difference, 0.11 [CI, 0.07 to 0.14]) but did not resolve urinary incontinence, with no significant dose-response association."

The full text of the study (open access here http://www.annals.org/cgi/content/full/148/6/459#F2) states: "Review of 10 RCTs (71–78, 128, 129) (n = 3633) of duloxetine administered for 3 to 12 weeks in women with predominantly stress urinary incontinence concluded that the drug failed to show better curative effects than placebo... However, improvement rates and quality-of-life scores were better after duloxetine than after placebo (pooled risk difference, 0.11 [CI, 0.07 to 0.14]; I2 = 6%).

The study further states: "Moderate consistent evidence from 4 RCTs suggested that women with both types of urinary incontinence were continent more often after pelvic floor muscle training and bladder training compared with regular care (Figure 2) (96, 99, 100, 102, 103). Despite baseline differences in age, type of urinary incontinence, methods to measure continence, and quality of the studies (Appendix Table 2), a pooled risk difference of 13% (0.13 [CI, 0.07 to 0.20]) was consistent across the studies (Appendix Table 3). Pelvic floor muscle training and bladder training also improved urinary incontinence (absolute risk difference, 0.36 [CI, 0.10 to 0.61]), but improvement was not consistent across the studies."

In plain language, duloxetine did not cure any SUI while pelvic floor muscle training + bladder training cured 13% of the cases and oxybutynin or tolterodine cured 18% of the cases. In the terms of "improvement" (made better but not quite cured) duloxetine showed improvement in 11% of patients while pelvic floor muscle training + bladder training showed improvement in 36% of the cases. 71.244.121.113 (talk) 14:51, 1 February 2009 (UTC)