Pharmacological management of fibromyalgia: a Bayesian network meta-analysis

ABSTRACT

Introduction

The identification of the most effective therapy for patients with fibromyalgia (FM) remains controversial. Thus, we conducted a Bayesian network meta-analysis to compare several drugs employed as pharmacological management for FM.

Areas covered

The following databases were accessed in October 2021: PubMed, Google Scholar, Embase, and Scopus. All the randomized clinical trials (RCTs) that compare two or more pharmacological management for fibromyalgia were accessed. Only studies involving a minimum of 10 patients with a length of follow-up longer than 4 weeks were included. The data from the fibromyalgia impact questionnaire (FIQ) and the physical and mental subscales short form 36 (SF36) were extracted at last follow-up. Additionally, the number of adverse events leading to the study of discontinuation was extracted. The compounds of interests were duloxetine, pregabalin, fluoxetine, gabapentin, milnacipran, trazodone, placebo, nortriptyline, IGF-I, amitriptyline, and the combination of fluoxetine and amitriptyline, pregabalin, and trazodone.

Expert opinion

According to published evidence, pregabalin, and duloxetine evidenced the greatest improvement of the FIQ and SF36 Physical and Mental subscales, along with the lowest rate of adverse events leading to study discontinuation. The results must be interpreted in light of possible adverse events associated with the use of these drugs.

KEYWORDS:

• Fibromyalgia
• pain
• depression
• drug
• pharmacological management

Article highlights

• The identification of the most effective therapy for patients with fibromyalgia remains controversial.

• Duloxetine, Pregabalin, Fluoxetine, Gabapentin, Milnacipran, Trazodone, Placebo, Nortriptyline, IGF-I, Amitriptyline and the combination of Fluoxetine and Amitriptyline, Pregabalin and Trazodone are commonly employed for the management of fibromyalgia.

• Pregabalin and duloxetine evidenced greater FIQ and SF36 Physical and Mental subscales, along with the lowest rate of adverse events leading to study discontinuation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

F Migliorini contributed to conceptualization, literature search, data extraction, statistical analysis, methodological quality assessment, and drafting; N Maffulli contributed to supervision, and revision; J Eschweiler contributed to supervision; M Knobe contributed to supervision; M Tingart contributed to supervision; G Colarossi contributed to the literature search, data extraction, methodological quality assessment, and drafting; all authors agree to be accountable for all aspects of the work and confirmed the final version of the manuscript.

Additional information

Funding

This paper was not funded.