Comparative reviews of fibromyalgia therapies

[participant1]

Has anyone published comparative reviews of drugs studied in fibromyalgia?

[diana.papshev]

As of July 2008, systematic comparative effectiveness reviews of agents used in the management of fibromyalgia have not been published.

The 2008 EULAR guidelines for the management of fibromyalgia include estimated effect sizes (pain and function) and numbers needed to harm; however, these estimates are based on limited available data. The following agents are recommended by EULAR based on Ib level of evidence:

o Tramadol
o Antidepressants: amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole
o Pramipexole and pregabalin

The latest US-based guidelines were issued in 2004 by the American Pain Society. According to the evidence available at that time, low-dose TCAs or cyclobenzaprine were positioned as a first-line pharmacotherapy while tramadol, SSRIs, SNRIs, and some anticonvulsants were positioned as second-line pharmacotherapy.

Note that fibromyalgia will be included in the next review of antiepileptic agents by the Drug Evaluation Review Project (DERP), which is scheduled for late 2008/early 2009

Sources:

Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008;67;536-541. Link to ePub released in late 2007

DERP. Final Reports.

Goldbenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292:2388-2395. Link to full-text article