Table 8Milnacipran compared with amitriptyline

Domains pertaining to strength of evidenceMagnitude of effectStrength of evidence
Number of studies; number of subjectsRisk of bias (design/quality)ConsistencyDirectnessPrecisionSummary effect size (95% confidence interval)High, Moderate, Low, Insufficient
Outcome 1
Pain: Difference in mean difference
Milnacipran 5, N=4118
Amitriptyline 3, N=207
RCT/FairConsistentIndirectImprecise0.44 (−0.81 to 1.70)Low
Outcome 2
50% Response in reduction of pain: Ratio of RR
Milnacipran 3, N=2038
Amitriptyline 2, N=68
RCT/FairConsistentIndirectImpreciseInsufficient data for comparisonInsufficient
Outcome 3
Fibromyalgia Impact Questionnaire: Difference in mean difference
Milnacipran 4, N=3993
Amitriptyline 1, N=80
RCT/fairNAIndirectImprecise3.82 (−7.96 to 15.61)Insufficient
Outcome 4
Fatigue: Difference in standardized mean difference
Milnacipran 4, N=3993
Amitriptyline, N=148
RCT/FairConsistentIndirectImprecise0.10 (−0.22 to 0.43)Low
Outcome 5
Overall withdrawal: Ratio of RR (95% CI)
Milnacipran 4, N=3230
Amitriptyline 4, N=287
RCT/FairConsistentIndirectImprecise1.96 (0.89 to 4.30)Low
Outcome 6
Overall adverse events: Ratio of RR (95%CI)
Milnacipran 3, N=3105
Amitriptyline 3, N=265
RCT/FairInconsistentIndirectImprecise0.77 (0.36 to 1.66)Insufficient
Outcome 7
Withdrawal due to adverse events: Ratio of RR (95% CI)
Milnacipran 4, N=3230
Amitriptyline 3, N=265
RCT/FairInconsistentIndirectImprecise1.94 (0.58 to 6.46)Insufficient

From: Appendix F, Strength of evidence

Cover of Drug Class Review: Drugs for Fibromyalgia
Drug Class Review: Drugs for Fibromyalgia: Final Original Report [Internet].
Smith B, Peterson K, Fu R, et al.
Portland (OR): Oregon Health & Science University; 2011 Apr.
Copyright © 2011, Oregon Health & Science University.

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