Clinical Characteristics and Medication Uses Among Fibromyalgia Patients Newly Prescribed Amitriptyline, Duloxetine, Gabapentin, or Pregabalin

Authors

  • Seoyoung C. Kim,

    Corresponding author
    1. Brigham and Women's Hospital, Boston, Massachusetts
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    • Dr. Kim has received a research grant from Pfizer.

  • Joan E. Landon,

    1. Brigham and Women's Hospital, Boston, Massachusetts
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  • Daniel H. Solomon

    1. Brigham and Women's Hospital, Boston, Massachusetts
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    • Dr. Solomon receives royalties from UpToDate; has received research grants from Amgen, Lilly, and the Consortium of Rheumatology Researchers of North America; and serves in unpaid roles on 2 Pfizer-sponsored trials.


Abstract

Objective

Fibromyalgia is a common chronic pain disorder with unclear etiology. No definitive treatment is available for fibromyalgia, and treatment with antidepressants or antiepileptics is often used for symptom management.

Methods

Using US health care utilization data, a large population-based cohort study was conducted to describe clinical characteristics and medication use patterns in patients diagnosed with fibromyalgia who newly started amitriptyline, duloxetine, gabapentin, or pregabalin.

Results

There were 13,404 amitriptyline starters, 18,420 duloxetine starters, 23,268 gabapentin starters, and 19,286 pregabalin starters. The mean age ranged from 48–51 years and 72–84% in each group were women. Back pain was the most frequent comorbidity in all 4 groups (range 48–64%) and hypertension, headache, depression, and sleep disorder were also common. The median daily dose at the start of followup was 25 mg for amitriptyline, 60 mg for duloxetine, 300 mg for gabapentin, and 75 mg for pregabalin, and >60% of patients remained on the same dose throughout the followup period. Only one-fifth of patients continued the treatment started for ≥1 year. The mean number of different prescription drugs at baseline ranged from 8–10 across the groups. More than one-half of patients took opioids and one-third took benzodiazepines, sleep disorder drugs, and muscle relaxants.

Conclusion

Patients who started 1 of the 4 common drugs for fibromyalgia similarly had multiple comorbidities and other fibromyalgia-related medication use, but continued the treatment only for a short time. The dose of the 4 drugs was not increased in most patients during the followup period.

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