SUMMARY OF FINDINGS
Amitriptyline, Duloxetine, Milnacipran, and Pregabalin vs placebo at 12 weeks (range of 4 to 52 weeks)
(10 studies: all low risk of bias*)
(8 studies: all low risk of bias)
(11 studies: all low risk of bias)
(7 studies: all low risk of bias)
|Pain (35 studies; 11,423 pts)||small reduction in pain||small reduction in pain||small reduction in pain||small reduction in pain|
|Sleep (16 studies; 4,452 pts)||large improvement in sleep||small improvement in sleep||no effect on sleep||moderate improvement in sleep|
|Depression (19 studies; 8,138 pts)||no effect on depression||small reduction in depression||small reduction in depression||small reduction in depression|
|Fatigue (21 studies; 8,172 pts)||moderate reduction in fatigue||small reduction in fatigue||small reduction in fatigue||small reduction in fatigue|
|Quality of Life (25 studies; 10,219 pts)||large improvement in quality of life||small improvement in quality of life||no effect on quality of life||small improvement in quality of life|
|Acceptability (stopping drug due to adverse effects) (26 studies; 9,833 pts)||not more likely than placebo to be stopped due to adverse effects||more likely than placebo to be stopped due to adverse effects||more likely than placebo to be stopped due to adverse effects||more likely than placebo to be stopped due to adverse effects|
*low risk of bias = low risk that the study has method or design errors that would affect the accuracy of the results
This was a systematic review of 36 randomized controlled studies published up to July 2020.
Who? This review included 11,930 adults (average age 48 years; 94% women) with fibromyalgia.
What? The reviewers included studies that compared amitriptyline with placebo or other drugs (duloxetine, milnacipran or pregabalin) for treatment of fibromyalgia.
Amitriptyline, 10 to 50 mg per day for 6 to 24 weeks
Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill."
Another treatment: Duloxetine, 60 to 120 mg per day for 12 to 52 weeks; Milnacipran, 25 to 200 mg per day for 12 to 52 weeks; Pregabalin, 150 to 600 mg per day for 8 to 17 weeks
Fibromyalgia is a condition that causes widespread pain lasting for at least 3 months without any apparent inflammation or damage to tissues. People with fibromyalgia often also experience fatigue, depression, anxiety, and sleep problems. Researchers wanted to know if amitriptyline, an older drug, is as good as three newer drugs for treatment of fibromyalgia. None of the studies directly compared amitriptyline with the newer drugs so researchers looked at the results for studies comparing each drug with placebo. The results showed amitriptyline improved most symptoms due to fibromyalgia except depression. Concerns about this review include lack of direct comparisons between amitriptyline and the other drugs.
This Evidence Summary is based on the following article:
Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2022 May 2;5(5):e2212939. doi: 10.1001/jamanetworkopen.2022.12939. PubMed
Published: Monday, October 31, 2022