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Critical Review| Volume 12, ISSUE 4, P407-415, April 2011

Systematic Review of the Comparative Effectiveness of Antiepileptic Drugs for Fibromyalgia

Published:December 13, 2010DOI:https://doi.org/10.1016/j.jpain.2010.09.007

      Abstract

      Fibromyalgia is a difficult-to-treat chronic pain syndrome that affects 2% of the US population. Pregabalin is an antiepileptic recently FDA approved for fibromyalgia treatment. Other antiepileptics have been suggested for treatment. This systematic review examines the relative benefits and harms of antiepileptic drugs in the treatment of fibromyalgia. A literature search was conducted and 8 studies matched criteria (7 studies of pregabalin, 1 of gabapentin). Both drugs reduced mean pain scores more than placebo at a modest rate (pregabalin, 38% to 50%; gabapentin, 51%). In a 6-month trial of pregabalin responders, 32% continued to have response at 6 months, with a mean time to loss of response of 34 days. Compared to placebo, the drugs had similarly high rates of adverse events and withdrawals. Without a head-to-head trial it is not possible to conclude if 1 antiepileptic is more effective or harmful than the other, although limited evidence suggests potential differences. Future studies must directly compare the drugs, include a more broadly defined population, examine long term benefits and harms, and include cointerventions. We conclude that pregabalin and gabapentin are modestly effective for the treatment of fibromyalgia but that their long-term safety and efficacy remain unknown.

      Perspective

      This systematic review evaluates the benefits and harms of using the antiepileptic drugs gabapentin and pregabalin for the treatment of fibromyalgia. Conclusions from this paper can help clinicians to more effectively treat the pain associated with fibromyalgia.

      Key words

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      References

        • Arnold L.M.
        • Crofford L.J.
        • Martin S.A.
        • Young J.P.
        • Sharma U.
        The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia.
        Pain Med. 2007; 8: 633-638
        • Arnold L.M.
        • Goldenberg D.L.
        • Stanford S.B.
        • Lalonde J.K.
        • Sandhu H.S.
        • Keck P.E.
        • Welge J.A.
        • Bishop F.
        • Stanford K.E.
        • Hess E.V.
        • Hudson J.I.
        Gabapentin in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled, multicenter trial.
        Arthritis Rheum. 2007; 56: 1336-1344
        • Arnold L.M.
        • Russell I.J.
        • Diri E.W.
        • Duan W.R.
        • Young J.P.
        • Sharma U.
        • Martin S.A.
        • Barrett J.A.
        • Haig G.
        A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia.
        J Pain. 2008; 9: 792-805
        • Buskila D.
        • Buskila D.
        Developments in the scientific and clinical understanding of fibromyalgia.
        Arthritis Res Ther. 2009; 11: 242
        • Calandre E.P.
        • Morillas-Arques P.
        • Rodriguez-Lopez C.M.
        • Rico-Villademoros F.
        • Hidalgo J.
        Pregabalin augmentation of quetiapine therapy in the treatment of fibromyalgia: An open-label, prospective trial.
        Pharmacopsychiatry. 2007; 40: 68-71
        • Chakrabarty S.
        • Zoorob R.
        • Chakrabarty S.
        • Zoorob R.
        Fibromyalgia.
        Am Fam Physician. 2007; 76: 247-254
        • Choy E.
        • Richards S.
        • Borwin K.
        • Watson P.
        • Lloyd A.
        • Sadosky A.
        • Zlateva G.
        Cost effectiveness of pregabalin in treatment of fibromyalgia from a UK perspective.
        Curr Med Res Opin. 2010; 26: 965-975
        • Crofford L.J.
        Pharmaceutical treatment options for fibromyalgia.
        Curr Rheumatol Rep. 2004; 6: 274-280
        • Crofford L.J.
        • Rowbotham M.C.
        • Mease P.J.
        • Russell I.J.
        • Dworkin R.H.
        • Corbin A.E.
        • Young J.P.
        • LaMoreaux L.K.
        • Martin S.A.
        • Sharma U.
        Pregabalin -105 Study G: Pregabalin for the treatment of fibromyalgia syndrome: Results of a randomized, double-blind, placebo-controlled trial.
        Arthritis Rheum. 2005; 52: 1264-1273
        • Crofford L.J.
        • Mease P.J.
        • Simpson S.L.
        • Young J.P.
        • Martin S.A.
        • Haig G.M.
        • Sharma U.
        Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): A 6-month, double-blind, placebo-controlled trial with pregabalin.
        Pain. 2008; 136: 419-431
        • Deary V.
        • Chalder T.
        • Sharpe M.
        The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review.
        Clin Psychol Rev. 2007; 27: 781-797
        • Egger M.
        • Zellweger-Zahner T.
        • Schneider M.
        • Junker C.
        • Lengeler C.
        • Antes G.
        Language bias in randomised controlled trials published in English and German.
        Lancet. 1997; 350: 326-329
        • Goldenberg D.L.
        Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain.
        Baillieres Best Pract Res Clin Rheumatol. 2007; 21: 499-511
        • Goodyear-Smith F.
        • Halliwell J.
        Anticonvulsants for neuropathic pain: Gaps in the evidence.
        Clin J Pain. 2009; 25: 528-536
        • Harris R.P.
        • Helfand M.
        • Woolf S.H.
        • Lohr K.N.
        • Mulrow C.D.
        • Teutsch S.M.
        • Atkins D.
        Methods Work Group Third U.S. Preventive Services Task Force: Current methods of the US Preventive Services Task Force: A review of the process.
        Am J Prev Med. 2001; 20: 21-35
        • Hassett A.L.
        • Gevirtz R.N.
        Nonpharmacologic treatment for fibromyalgia: Patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine.
        Rheum Dis Clin North Am. 2009; 35: 393-407
        • Hudson J.I.
        • Goldenberg D.L.
        • Pope Jr., H.G.
        • Keck Jr., P.E.
        • Schlesinger L.
        Comorbidity of fibromyalgia with medical and psychiatric disorders.
        Am J Med. 1992; 92: 363-367
        • Jensen T.S.
        • Madsen C.S.
        • Finnerup N.B.
        Pharmacology and treatment of neuropathic pains.
        Curr Opin Neurol. 2009; 22: 467-474
        • Lawrence R.C.
        • Felson D.T.
        • Helmick C.G.
        • Arnold L.M.
        • Choi H.
        • Deyo R.A.
        • Gabriel S.
        • Hirsch R.
        • Hochberg M.C.
        • Hunder G.G.
        • Jordan J.M.
        • Katz J.N.
        • Kremers H.M.
        • Wolfe F.
        Estimates of the prevalence of arthritis and other rheumatic conditions in the United States.
        Part II. Arthritis Rheum. 2008; 58: 26-35
        • Lipkovich I.
        • Adams D.H.
        • Mallinckrodt C.
        • Faries D.
        • Baron D.
        • Houston J.P.
        Evaluating dose response from flexible dose clinical trials.
        BMC Psychiatry. 2008; 8: 1471-1480
      1. McEvoy G.K. AHFS: Drug Information. American Society of Health-System Pharmacists, Bethesda, MD2008: 1125-1126
        • Mease P.J.
        • Russell I.J.
        • Arnold L.M.
        • Florian H.
        • Young J.P.
        • Martin S.A.
        • Sharma U.
        A randomized, double-blind, placebo-controlled, phase III trial of pregabalin in the treatment of patients with fibromyalgia.
        Journal Rheumatol. 2008; 35: 502-514
        • Moher D.
        • Pham B.
        • Klassen T.P.
        • Schulz K.F.
        • Berlin J.A.
        • Jadad A.R.
        • Liberati A.
        What contributions do languages other than English make on the results of meta-analyses?.
        J Clin Epidemiol. 2000; 53: 964-972
        • Owens D.K.
        • Lohr K.N.
        • Atkins D.
        • Treadwell J.R.
        • Reston J.T.
        • Bass E.B.
        • Chang S.
        • Helfand M.
        Grading the strength of a body of evidence when comparing medical interventions–Agency for Healthcare Research and Quality and the Effective Health Care Program.
        J Clin Epidemiol. 2010; 63: 513-523
        • Russell I.J.
        • Larson A.A.
        Neurophysiopathogenesis of fibromyalgia syndrome: A unified hypothesis.
        Rheum Dis Clin North Am. 2009; 35: 421-435
        • Sackett D.L.
        • Straus S.E.
        • Richardson W.S.
        • Rosenberg W.
        • Haynes R.B.
        Evidence-Based Medicine: How to Practice and Teach EBM.
        JAMA. 2000; 284: 2382-2383
        • Sarzi-Puttini P.
        • Torta R.
        • Marinangeli F.
        • Biasi G.
        • Spath M.
        • Buskila D.
        • Gracely R.H.
        • Giamberardino M.A.
        • Bazzichi L.
        • Cazzola M.
        • Di Franco M.
        • Stisi S.
        • Salaffi F.
        • Casale R.
        • Leardini G.
        • Gorla R.
        • Marsico A.
        • Carignola R.
        • Altomonte L.
        • Ceccherelli F.
        • Cassisi G.
        • Arioli G.
        • Alciati A.
        • Atzeni F.
        • Italian Fibromyalgia N.
        Fibromyalgia syndrome: The pharmacological treatment options.
        Reumatismo. 2008; 60: 50-58
        • White L.A.
        • Birnbaum H.G.
        • Kaltenboeck A.
        • Tang J.
        • Mallett D.
        • Robinson R.L.
        Employees with fibromyalgia: Medical comorbidity, healthcare costs, and work loss.
        J Occup Environ Med. 2008; 50: 13-24
        • Wolfe F.
        • Smythe H.A.
        • Yunus M.B.
        • Bennett R.M.
        • Bombardier C.
        • Goldenberg D.L.
        • Tugwell P.
        • Campbell S.M.
        • Abeles M.
        • Clark P.
        The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.
        Arthritis Rheum. 1990; 33: 160-172
        • Wolfe F.
        • Ross K.
        • Anderson J.
        • Russell I.J.
        • Hebert L.
        The prevalence and characteristics of fibromyalgia in the general population.
        Arthritis Rheum. 1995; 38: 19-28