Selective serotonin reuptake inhibitors for fibromyalgia syndrome

Abstract

Background Fibromyalgia is a clinically well-defined chronic condition with a biopsychosocial aetiology. Fibromyalgia is characterized by chronic widespread musculoskeletal pain, sleep problems, cognitive dysfunction, and fatigue. Patients often report high disability levels and poor quality of life. Since there is no specific treatment that alters the pathogenesis of fibromyalgia, drug therapy focuses on pain reduction and improvement of other aversive symptoms. Objectives The objective was to assess the benefits and harms of selective serotonin reuptake inhibitors (SSRIs) in the treatment of fibromyalgia. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5), MEDLINE (1966 to June 2014), EMBASE (1946 to June 2014), and the reference lists of reviewed articles. Selection criteria We selected all randomized, double-blind trials of SSRIs used for the treatment of fibromyalgia symptoms in adult participants. We considered the following SSRIs in this review: citalopram, fluoxetine, escitalopram, fluvoxamine, paroxetine, and sertraline. Data collection and analysis Three authors extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion. Main results The quality of evidence was very low for each outcome. We downgraded the quality of evidence to very low due to concerns about risk of bias and studies with few participants. We included seven placebo-controlled studies, two with citalopram, three with fluoxetine and two with paroxetine, with a median study duration of eight weeks (4 to 16 weeks) and 383 participants, who were pooled together. All studies had one or more sources of potential major bias. There was a small (10%) difference in patients who reported a 30% pain reduction between SSRIs (56/172 (32.6%)) and placebo (39/171 (22.8%)) risk difference (RD) 0.10, 95% confidence interval (CI) 0.01 to 0.20; number needed to treat for an additional beneficial outcome (NNTB) 10, 95% CI 5 to 100; and in global improvement (proportion of patients who reported to be much or very much improved: 50/168 (29.8%) of patients with SSRIs and 26/162 (16.0%) of patients with placebo) RD 0.14, 95% CI 0.06 to 0.23; NNTB 7, 95% CI 4 to 17. SSRIs did not statistically, or clinically, significantly reduce fatigue: standard mean difference (SMD) −0.26, 95% CI −0.55 to 0.03; 7.0% absolute improvement on a 0 to 10 scale, 95% CI 14.6% relative improvement to 0.8% relative deterioration; nor sleep problems: SMD 0.03, 95 % CI −0.26 to 0.31; 0.8 % absolute deterioration on a 0 to 100 scale, 95% CI 8.3% relative deterioration to 6.9% relative improvement. SSRIs were superior to placebo in the reduction of depression: SMD −0.39, 95% CI −0.65 to −0.14; 7.6% absolute improvement on a 0 to 10 scale, 95% CI 2.7% to 13.8% relative improvement; NNTB 13, 95% CI 7 to 37. The dropout rate due to adverse events was not higher with SSRI use than with placebo use (23/146 (15.8%) of patients with SSRIs and 14/138 (10.1%) of pati...

Impact of Polypharmacy on Candidate Biomarker miRNomes for the Diagnosis of Fibromyalgia and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Striking back on Treatments

“…Rather than analyzing the quality of evidence of clinical trials using these substances, we were interested in assigning the active principle and IUPAC names to the reported compounds, to facilitate our downstream analysis (Table 3). Additional literature supporting the use of compounds for each of the six classes described by Häuser et al, to treat FM patients is provided in Table 3 [76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93].…”

“…Collatz A et al, 2016 [97] Proliferation inductor from B cells Although possibly not complete, Tables 3 and 4 include the most representative compounds to treat FM and ME/CFS according to the consulted authors [44,48,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][99][100][101][102][103][104][105][106][107]. Unexpectedly, a single IUPAC overlap, corresponding to the Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine, was found for drugs commonly prescribed for FM and ME/CFS (in bold in Tables 3 &4); indicating little prescription overlap at the IUPAC name level despite both groups of patients presenting common symptomatology.…”

Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology

“…A recent Cochrane review concluded that there was no unbiased evidence with regards to superiority of SSRIs to placebo in treating the key symptoms of fibromyalgia (pain, fatigue and sleep problems), however they might be considered for treating depression in this group of patients [28]. National and international guidelines are mixed with regards to their recommendations on SSRIs.…”

Fibromiyaljide Farmakolojik Tedavi

“…Klinik pratikte fibromiyalji tedavisinde çok sık kullanılan selektif serotonin geri alım inhibitörleri (sitolopram, fuloksetin, esitalopram, floksamin, paroksetin, sertralin) plaseboya kıyasla hastalığın major semptomları olan ağrı, yorgunluk ve uyku problemleri üzerine daha etkili olduğuna dair hala yeterli kanıt yoktur. Bununla birlikte bu ilaçlar fibromiyaljiye eşlik eden depresyon tedavisinde çok etkilidirler 37 .…”