Three drugs are approved for use by fibromyalgia patients in the U.S. and five more are recommended by the American College of Rheumatology. That would seem to be a pretty good basket of drugs to choose from but a recent large survey suggested that quantity was no reflection of quality.
This study used a retrospective analysis of insurance company records to determine which drugs over 240,000 FM patients tried and which ones they stuck with over two years. (Now that's a big database..) Most of the patients diagnosed with FM were women but a substantial percentage were men (32%).
[fright]
[/fright]The news was not good for the FM drug makers. For one, most doctors don't appear to know how to administer these drugs. For another, despite the fact that FM patients in the U.S. and Europe spend about $1.8 billion a year on FM drugs, they do not appear to be happy with their treatment; they frequently switched drugs and ultimately often let them lapse.
J Manag Care Spec Pharm. 2016 Mar;22(3):263-71. doi: 10.18553/jmcp.2016.22.3.263.Treatment Patterns Associated with ACR-Recommended Medications in the Management of Fibromyalgia in the United States. Liu Y1, Qian C2, Yang M2.
The survey suggested that most doctors were either reluctant to begin drug treatment or didn't know of it. Less than a third of FM patients began treatment using drugs recommended by the American College of Rheumatology (pregabalin (Lyrica), gabapentin (Neurontin), duloxetine (Cymbalta), milnacipran (Savella), cyclobenzaprine (Flexeril), tramadol, amitriptyline (Elavil) and venlafaxine (Effexor)). Of those who did the fact that many received a lower than suggested dose suggested doctors were not fully informed.
Of the six drugs assessed (Lyrica, Neurontin, Cymbalta, Savella, Flexeril, Tramadol) Cymbalta was the most commonly used. It was also the most successful drug; it was the only drug that patients used for more than 50% of the time covered by the survey. Over 50% of patients dropped all the other medications before six months was up.
Many of those who continued their use of a drug weren't satisfied with it as 50% added another drug within a year.
For the others either doctors weren't giving their patients with more options or the patients simply weren't interested in trying them as only 30% of patients tried another drug within 90 days of their first drug not working out.
All in all the survey suggested that doctors are not well informed about FM drugs, that patients may be receiving too low of doses of the drugs to be effective, that they are not satisfied with their drugs and switch them often and that they may not be offered all the options present to them.
This may not be an unusual finding for FM and similar pain conditions. A similar survey of diabetic patients with neuropathic pain also indicated that they tended to receive lower than recommended doses and that they frequently discontinued the drugs they did get. The authors concluded that treatment efficacy for neuropathic pain was very poor.
Another study concluded that prescriptions of amitriptyline, duloxetine, gabapentin, or pregabalin had little for no effect on health care utilization by FM patients; that is, being prescribed one or more of these drugs did not reduce their number of doctor visits. (Duloxetine was better than Lyrica in this regard possibly because it was able to reduce depression.) This study also found high drug discontinuation rates for FM.
Four drugs are likely to enter the market for FM over the next couple of years. If these studies are accurate they will probably find a receptive audience.
This study used a retrospective analysis of insurance company records to determine which drugs over 240,000 FM patients tried and which ones they stuck with over two years. (Now that's a big database..) Most of the patients diagnosed with FM were women but a substantial percentage were men (32%).
[fright]
J Manag Care Spec Pharm. 2016 Mar;22(3):263-71. doi: 10.18553/jmcp.2016.22.3.263.Treatment Patterns Associated with ACR-Recommended Medications in the Management of Fibromyalgia in the United States. Liu Y1, Qian C2, Yang M2.
The survey suggested that most doctors were either reluctant to begin drug treatment or didn't know of it. Less than a third of FM patients began treatment using drugs recommended by the American College of Rheumatology (pregabalin (Lyrica), gabapentin (Neurontin), duloxetine (Cymbalta), milnacipran (Savella), cyclobenzaprine (Flexeril), tramadol, amitriptyline (Elavil) and venlafaxine (Effexor)). Of those who did the fact that many received a lower than suggested dose suggested doctors were not fully informed.
Of the six drugs assessed (Lyrica, Neurontin, Cymbalta, Savella, Flexeril, Tramadol) Cymbalta was the most commonly used. It was also the most successful drug; it was the only drug that patients used for more than 50% of the time covered by the survey. Over 50% of patients dropped all the other medications before six months was up.
Many of those who continued their use of a drug weren't satisfied with it as 50% added another drug within a year.
For the others either doctors weren't giving their patients with more options or the patients simply weren't interested in trying them as only 30% of patients tried another drug within 90 days of their first drug not working out.
All in all the survey suggested that doctors are not well informed about FM drugs, that patients may be receiving too low of doses of the drugs to be effective, that they are not satisfied with their drugs and switch them often and that they may not be offered all the options present to them.
This may not be an unusual finding for FM and similar pain conditions. A similar survey of diabetic patients with neuropathic pain also indicated that they tended to receive lower than recommended doses and that they frequently discontinued the drugs they did get. The authors concluded that treatment efficacy for neuropathic pain was very poor.
Another study concluded that prescriptions of amitriptyline, duloxetine, gabapentin, or pregabalin had little for no effect on health care utilization by FM patients; that is, being prescribed one or more of these drugs did not reduce their number of doctor visits. (Duloxetine was better than Lyrica in this regard possibly because it was able to reduce depression.) This study also found high drug discontinuation rates for FM.
Four drugs are likely to enter the market for FM over the next couple of years. If these studies are accurate they will probably find a receptive audience.
Last edited:
![ME/CFS lecture | Dr Nancy Klimas | 2011 [Chronic Fatigue Syndrome / SEID / New Zealand] - YouTube](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
