Two Meds That Work in Fibromyalgia

Two papers were presented at the American Academy of Pain Medicine meeting describe clinical studies of drugs that are effective and safe in treating fibromyalgia.  They are summarized on the website Medpage today.

The first medication, milnacipran (Savella®), was studied in two large clinical trials; one lasted 27 weeks, the other had a 15-week follow-up.  Over 2,000 patients were included in the 2 studies, using doses of 100 or 200 mg daily.  At 15 weeks, half the patients had a 30% or better improvement in pain scores, and 35%-40% of the patients had at least a 50% improvement.  The improvements in placebo patients were high, but significantly lower than those for milnacipran.

The second medication was duloxetine (Cymbalta®), an antidepressive agent, which was studied in fibromyalgia patients with pain and accompanying depression.  Both conditions were improved by duloxetine in result pooled from 4 clinical trials.  35% to 45% of the patients given duloxetine had a 50% or greater improvement in pain scores, whether they had depression or not. Differences from placebo results were statistically significant, except for patients with a low depression score at baseline.  Analyses showed that about 70% of pain improvement was attributable to a direct action of the drug, with 30% due to an indirect effect of duloxetine on depression.

Both these drugs are antidepressants, so their beneficial effects in fibromyalgia patients are not surprising.  They are relatively new drugs, and both may find a regular place among other antidepressants, analgesics, and anticonvulsives, in the difficult task of relieving the symptoms of this distressing disease.