1610 - An 11-Year Longitudinal Study of Pharmacologic Therapy in Fibromyalgia

Monday, November 7, 2011: 3:45 PM
W190a (McCormick Place West)
Frederick Wolfe, National Data Bank for Rheumatic Diseases, Wichita, KS, Brian T. Walitt, Washington Hospital Center, Washington, DC, Robert S. Katz, Rush University Medical Center, Chicago, IL, Yvonne C. Lee, Brigham and Women's Hospital, Boston, MA, Kaleb D. Michaud, Univ of Nebraska Med Ctr & National Data Bank for Rheumatic Diseases, Omaha, NE and Winfried Häuser, Technische Universität München, Munich, Germany
Presentation Number: 1610

Background/Purpose: Fibromyalgia pharmacotherapy has undergone significant changes in the last decade with recommendations regarding opioids and the introduction of FDA-approved serotonin-norepinephrine reuptake inhibitors (SNRI) such as duloxetine and milnacipran and narcoleptic drugs such as pregabalin and gabapentin. SNRIs and anticonvulsants are heavily promoted to physicians and direct-to-patient advertising. However, there are few data on the prevalence of use of fibromyalgia treatments and their effect on the outcome of fibromyalgia. We report here the results of an 11 study of fibromyalgia pharmacotherapy.

Method:  We used a longitudinal fibromyalgia databank that assessed drug use and outcome variables at semi-annual intervals on 2,870 patients during 18,452 observations. We assessed outcomes by VAS pain and fatigue scales, and the HAQ functional disability index. Prevalence estimates were based on generalized estimating equations (GEE), and adjusted for demographic and severity variables.

Result: NSAID use fell from 73% in 2000 to 44% in 2010. At similar intervals strong opioids increased from 6% to 12% and weak opioids from 35% to 40%. Overall, non-NSAID analgesic use increased from 63% to 68%. During the same period the group of tricyclic antidepressants, SNRIs and anticonvulsants increased from 34% to 49% (Figure 1). These changes were brought about by a decrease in tricyclic use from 26% to 16% and increases in anticonvulsants from 9% to 26% and in SNRIs from 0% to 21%.

The mean pain, fatigue and HAQ disability scores were 5.6 (SD 2.6), 6.3 (2.8) and 1.2 (0.7), respectively, and these scores remained high and changed almost not at all over the 11-year period (Figure 2). In addition, the total drug cost ($2007) increased from $459 to $1,345.

Conclusion:  Strong and weak opioid use remains high in fibromyalgia despite recommendations against opioids. Switching from inexpensive generic trycyclics to newer and expensive SNRIs and anticonvulsant agents was common. Drug costs increased substantially, but despite changes in therapy, no clinically significant changes in pain, fatigue or function were noted during 11 years of follow-up.

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Keywords: fibromyalgia, outcome measures and pharmacology

Disclosure: F. Wolfe, None; B. T. Walitt, Jazz Pharmaceuticals, 5 ; R. S. Katz, Forrest Pharmaceuticals, 8 ; Y. C. Lee, Merck, Novartis, Elan, 1, Forrest Research Institute, 2 ; K. D. Michaud, None; W. Häuser, Dr. Häuser has received honoraria for educational lectures from Eli-Lilly & Company, Janssen-Cilag and Pfizer, and congress travel support from Eli Lilly & Company in the previous 3 years"., 8 .