Abstract
This Practice Point commentary discusses the first two trials of long-term drug treatment in fibromyalgia. In Russell et al.'s study, 33% of patients receiving 6-month treatment with 60 mg/day duloxetine responded to therapy; the number needed to treat was seven. In the three treatment arms, 15% (60 mg/day duloxetine), 27% (120 mg/day duloxetine) and 13% (placebo) of patients discontinued treatment because of adverse events (the most common being nausea [24%] and fatigue [14%]). In Crofford et al.'s study, 32% of patients who received pregabalin had loss of therapeutic response, compared with 61% of patients treated with placebo. The discontinuation rate due to adverse events (dizziness in 36% of cases and somnolence in 22%) during the randomized treatment phase was 16% with pregabalin and 7% with placebo. This commentary discusses the implications of these trials for clinical practice and considers areas for future research in the field. In view of the current results, duloxetine and pregabalin could be administered together and as part of multimodal and multidisciplinary therapy, but treatment should 'start low and go slow'.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis
BMC Musculoskeletal Disorders Open Access 28 June 2010
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
Purchase on Springer Link
Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Wolfe F et al. (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33: 160–172
Vitton O et al. (2004) A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia. Hum Psychopharmacol 19 (Suppl 1): S27–S35
Arnold LM et al. (2004) A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depression disorder. Arthritis Rheum 50: 2974–2984
Crofford LJ et al. (2005) Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 52: 1264–1273
Russell IJ et al. (2008) Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 136: 432–444
Crofford LJ et al. (2008) Fibromyalgia relapse evaluation and efficacy for durability on meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin. Pain 136: 419–431
Yunus MB (2007) Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum 37: 339–352
Carville SF et al. (2007) EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 67: 536–541
Acknowledgements
The author would like to thank Rosemary Ancelle-Park at Public Health, Paris, France.
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author has received grant/research support from Bristol-Myers Squibb, Jazz Pharmaceuticals and Pierre Fabre, and is a consultant for Bristol-Myers Squibb, Grünenthal, Eli Lilly, Pfizer and Pierre Fabre.
Rights and permissions
About this article
Cite this article
Serra, E. Duloxetine and pregabalin: safe and effective for the long-term treatment of fibromyalgia?. Nat Rev Neurol 4, 594–595 (2008). https://doi.org/10.1038/ncpneuro0936
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneuro0936
This article is cited by
-
Identification of symptom and functional domains that fibromyalgia patients would like to see improved: a cluster analysis
BMC Musculoskeletal Disorders (2010)