Comparison of Selective Serotonin Reuptake Inhibitors and USA Food and Drug Administration-Approved Serotonin-Norepinephrine Reuptake Inhibitors Treatments for Fibromyalgia: A Systematic Review and Network Meta-Analysis
Author(s)
Darsh D. Devani, MS in Pharmaceutical Economics and Policy1, Hussein Mohammed Farag, MSc, PharmD1, Joanne Doucette, MLIS1, Ismaeel U. Yunusa, PharmD, PhD2, Tewodros Eguale, PhD, MD1.
1MCPHS University, Boston, MA, USA, 2University of South Carolina College of Pharmacy, Columbia, SC, USA.
1MCPHS University, Boston, MA, USA, 2University of South Carolina College of Pharmacy, Columbia, SC, USA.
Presentation Documents
OBJECTIVES: To evaluate the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in treating fibromyalgia, a chronic disorder characterized by widespread pain, fatigue, and cognitive disturbances.
METHODS: A systematic literature review and network meta-analysis (NMA) were conducted as per PRISMA guidelines. PubMed, EMBASE, and Cochrane Library were searched up to September 17, 2023. Studies were selected based on PICOS criteria, focusing on adults diagnosed with fibromyalgia and comparing SSRIs/SNRIs to placebo or active comparators. Data were analyzed using Stata version 18, with standardized mean differences (SMDs) used for continuous outcomes.
RESULTS: A total of 21 randomized controlled trials (RCTs) involving 6,953 participants were included. The NMA revealed that Milnacipran doses (200mg, 100mg), and Duloxetine 60mg were associated with significant improvements in the pain, outcome. SUCRA plots indicated that Milnacipran 200mg had the highest probability of being the most effective treatment for pain (79.6%), while Duloxetine 60mg ranked highest for sleep improvement (63.4%). Cluster plots further supported these findings, showing clear groupings of treatments based on their efficacy profiles. Specifically, Milnacipran 200mg and Duloxetine 60mg formed distinct clusters for pain and sleep improvement, respectively. Additionally, Duloxetine 60mg was most effective for both sleep and depression improvement, while Milnacipran 200mg was most effective for pain and depression improvement. These findings align with previous studies highlighting the effectiveness of these treatments in managing fibromyalgia symptoms.
CONCLUSIONS: The NMA supports the therapeutic effectiveness of paroxetine, duloxetine, and milnacipran for fibromyalgia. Paroxetine, although used off-label, showed promise in improving sleep and pain. Treatment decisions should consider individual patient preferences and symptom profiles. Future NMAs should incorporate a broader range of pharmacological modalities to provide more robust evidence.
METHODS: A systematic literature review and network meta-analysis (NMA) were conducted as per PRISMA guidelines. PubMed, EMBASE, and Cochrane Library were searched up to September 17, 2023. Studies were selected based on PICOS criteria, focusing on adults diagnosed with fibromyalgia and comparing SSRIs/SNRIs to placebo or active comparators. Data were analyzed using Stata version 18, with standardized mean differences (SMDs) used for continuous outcomes.
RESULTS: A total of 21 randomized controlled trials (RCTs) involving 6,953 participants were included. The NMA revealed that Milnacipran doses (200mg, 100mg), and Duloxetine 60mg were associated with significant improvements in the pain, outcome. SUCRA plots indicated that Milnacipran 200mg had the highest probability of being the most effective treatment for pain (79.6%), while Duloxetine 60mg ranked highest for sleep improvement (63.4%). Cluster plots further supported these findings, showing clear groupings of treatments based on their efficacy profiles. Specifically, Milnacipran 200mg and Duloxetine 60mg formed distinct clusters for pain and sleep improvement, respectively. Additionally, Duloxetine 60mg was most effective for both sleep and depression improvement, while Milnacipran 200mg was most effective for pain and depression improvement. These findings align with previous studies highlighting the effectiveness of these treatments in managing fibromyalgia symptoms.
CONCLUSIONS: The NMA supports the therapeutic effectiveness of paroxetine, duloxetine, and milnacipran for fibromyalgia. Paroxetine, although used off-label, showed promise in improving sleep and pain. Treatment decisions should consider individual patient preferences and symptom profiles. Future NMAs should incorporate a broader range of pharmacological modalities to provide more robust evidence.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO56
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)