Duloxetine, pregabalin, and milnacipran for treating fibromyalgia
Fibromyalgia (FM) is a medical condition represented by chronic widespread pain and a heightened pain response to pressure which affects muscles and soft tissue. A study was done to analyze the relative efficacy and tolerability of duloxetine, pregabalin, and milnacipran at the recommended doses in fibromyalgia.
The study was based on a Bayesian network meta-analysis of randomized controlled trials considering the efficacy and safety of duloxetine 60 mg, pregabalin 300 mg, pregabalin 150 mg, milnacipran 200 mg and milnacipran 100 mg compared to placebo in patients with fibromyalgia. Nine RCTs encompassing 5140 patients met the inclusion criteria.
The proportion of patients with >30% upgradation from baseline in pain was significantly higher in duloxetine 60 mg, pregabalin 300 mg, milnacipran 100 mg, and milnacipran 200 mg groups than placebo group [pairwise odds ratio (OR) 2.33, 95 % credible interval (CrI) 1.50–3.67; OR 1.68, 95 % CrI 1.25–2.28; OR 1.62, 95 % CrI 1.16–2.25; and OR 1.61; 95 % CrI 1.15–2.24, respectively]. The ranking probability based on surface under the cumulative ranking curve (SUCRA) revealed that duloxetine 60 mg had the highest probability of being the ace treatment for achieving response level (SUCRA = 0.9431), then pregabalin 300 mg (SUCRA = 0.6300), milnacipran 100 mg (SUCRA = 0.5680), milnacipran 200 mg (SUCRA = 0.5617), pregabalin 150 mg (SUCRA = 0.2392), and placebo (SUCRA = 0.0580).
The probability of withdrawal due to adverse events was lower in placebo group than pregabalin 300 mg, duloxetine 60 mg, milnacipran 100 mg, and milnacipran 200 mg groups. But, there was no significant change in the efficacy and tolerability between the medications at the advised doses. It was concluded that duloxetine 60 mg, pregabalin 300 mg, milnacipran 100 mg, and milnacipran 200 mg were more efficacious than placebo. However, there was no significant difference in the efficacy and tolerability between the medications at the recommended doses.