Pregabalin plus duloxetine for fibromyalgia
Fibromyalgia induces chronic widespread pain which is related with depression, fatigue, sleep disturbance, and cognitive dysfunction. The supportive evidence is less although polypharmacy is commonly used. Many fibromyalgia trials are primarily based on pain reduction with monotherapy. A study has been done that distinguished a pregabalin–duloxetine combination to each monotherapy.
In study, the design was used in which the participants acquired maximally tolerated doses of placebo, pregabalin, duloxetine, and pregabalin–duloxetine combination for 6 weeks. The primary result was daily pain (0-10); secondary outcomes inculcated global pain relief, Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. Of total 41 participants randomized, 39 accomplished ≥2 treatments. Daily pain during placebo, pregabalin, duloxetine, and combination was 5.1, 5.0, 4.1, and 3.7, respectively (P < 0.05 only for combination vs placebo, and pregabalin). Participants (%) reporting ≥ moderate global pain ease were 18%, 39%, 42%, and 68%, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). Fibromyalgia Impact Questionnaire scores were 42.9, 37.4, 36.0, and 29.8 respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). SF-36 scores were 50.2, 55.7, 56.0, and 61.2 respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). The medical Outcomes Study Sleep Scale scores were 48.9, 35.2, 46.1, and 32.1 respectively (P < 0.05 only for combination vs placebo, and duloxetine). BDI-II scores were 11.9, 9.9, 10.7, and 8.9, respectively (P < 0.05 only for combination vs placebo). During combination vs placebo, the moderate–severe drowsiness was more frequent.
Thus, integrating pregabalin and duloxetine for fibromyalgia improves multiple clinical outcomes vs monotherapy. For fibromyalgia, continued research should compare this and other combinations to monotherapy.