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

Conclusions

We found eligible studies of treatment for fibromyalgia with amitriptyline, nortriptyline, citalopram, fluoxetine, paroxetine, cyclobenzaprine, pregabalin, gabapentin, milnacipran, and duloxetine. We found no eligible studies with the other included drugs and no eligible studies of included interventions when used as adjunctive therapy. Head-to-head trials were few, and provided low-strength evidence that short-term treatment with immediate-release paroxetine is superior to amitriptyline in reducing pain and sleep problems and provided low-strength evidence there are no significant differences between amitriptyline as compared to cyclobenzaprine and nortriptyline. Although there were some significant differences between drugs in overall adverse events, they did not produce any differences in withdrawals due to adverse events. Additionally, based on indirect comparison meta-analysis, we found low evidence that duloxetine was superior to milnacipran on outcomes of pain, sleep disturbance, depressed mood, and health-related quality of life. We found low evidence that both duloxetine and milnacipran were superior to pregabalin on improvement in depressed mood, whereas pregabalin was superior to milnacipran on improvement in sleep disturbance. Amitriptyline was similar to duloxetine, milnacipran, and pregabalin on outcomes of pain and fatigue with insufficient data on the other outcomes. Although there were some significant differences between duloxetine, milnacipran, and pregabalin in specific adverse events, they did not produce any differences in overall withdrawals, overall adverse events, and withdrawals due to adverse events. Amitriptyline was no different than duloxetine, milnacipran, and pregabalin in overall withdrawals with insufficient evidence to report on comparative overall adverse events and withdrawals due to adverse events. For the remaining drugs, there was only evidence of significant improvements in pain over placebo in 1 trial for gabapentin, 1 of 3 trials for cyclobenzaprine, and in 1 trial of fluoxetine. But, no conclusions can be drawn about comparative effectiveness or harms among these drugs because the numbers of trials/patients in placebo-controlled trials were too few to provide meaningful results in indirect comparisons. There was a small body of evidence suggesting that duloxetine was not effective on pain reduction in male, nonwhite, and older patients based on a small sample size that was underpowered to detect a difference. Compared with placebo, duloxetine, fluoxetine, controlled-release paroxetine, and pregabalin significantly improved fibromyalgia symptoms regardless of baseline depression but a significant milnacipran effect compared with placebo was only observed in nondepressed patients. Controlled-release paroxetine and pregabalin significantly improved fibromyalgia symptoms regardless of baseline anxiety.

Copyright © 2011, Oregon Health & Science University.
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.

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