Alpha-lipoic acid, epalrestat, and mecobalamin are widely used as monotherapies for diabetic peripheral neuropathy. However, whether a triple-combination therapy with these three drugs is superior to monotherapy or dual therapy remains debatable. Nine randomized controlled trials were identified through a search on electronic databases such as PubMed, Web of Science, and Cochrane Library. The trial participants ( = 1153) were divided into the experimental group who received the triple-combination therapy and the control group who received conventional or dual therapy with the aforementioned drugs. Therapeutic outcomes were better in the experimental group than in the control group (odds ratio: 3.74; 95 % confidence interval: 2.57–5.45; = 0 %; < 0.00001). No statistic difference was noted in adverse effects. Compared with the control group, the experimental group exhibited significant improvements in median motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and vibration perception thresholds (VPT) in the left and right lower limbs. In the control group, a subgroup analysis by treatment strategy revealed similar improvements in total efficacy, MNCV, and SNCV. For diabetic peripheral neuropathy, the triple-combination therapy may be more effective than monotherapy or dual therapy.

中文翻译：

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糖尿病周围神经病变的疾病缓解疗法：随机对照试验的系统评价和荟萃分析

α-硫辛酸、依帕司他和甲钴胺被广泛用作糖尿病周围神经病变的单一疗法。然而，这三种药物的三联疗法是否优于单一疗法或双重疗法仍然存在争议。通过对 PubMed、Web of Science 和 Cochrane Library 等电子数据库的搜索，确定了九项随机对照试验。试验参与者（= 1153）被分为接受三联疗法的实验组和接受上述药物的常规或双重疗法的对照组。实验组的治疗结果优于对照组（比值比：3.74；95% 置信区间：2.57–5.45；= 0%；< 0.00001）。不良反应没有统计学差异。与对照组相比，实验组的正中运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）、腓骨MNCV、腓骨SNCV以及左右下肢振动知觉阈值（VPT）均有显着改善。在对照组中，按治疗策略进行的亚组分析显示总疗效、MNCV 和 SNCV 方面有类似的改善。对于糖尿病周围神经病变，三联疗法可能比单一疗法或双重疗法更有效。