Pregabalin as monotherapy enough to manage fibromyalgia

Pregabalin, used either alone or in combination with milnacipran, is effective in the treatment of patients with fibromyalgia, and combined therapy does not confer added benefits compared with monotherapy, according to a study.

The study randomized 58 female fibromyalgia patients to receive pregabalin 150 mg twice daily alone (n=29) or with milnacipran 50 mg twice daily (n=29) for 3 months. The median disease duration was 2 years, with an average tender point count of 14.

Patients in the combination arm had a numerically higher visual analogue scale (VAS) and fibromyalgia impact questionnaire (FIQ) scores, with 22 (84.6 percent) of them having severe pain (VAS ≥70) as compared with 15 (65.2 percent) in the monotherapy group. Pain was significantly correlated with disease impact at baseline in both groups.

The dropout rate was 20.7 with monotherapy and 10.3 percent with combination. At the follow‐up assessment, patients in both groups showed a statistically significant improvement in VAS and FIQ scores (p<0.001).

More patients on combination than on monotherapy achieved significant improvement in pain, disease impact, and sleep pattern. However, the difference was not clinically meaningful.

In light of the results, the researchers acknowledged that a population-based, multicentric study may reveal more significant findings. They suggested that future studies consider adding a placebo control and milnacipran comparator groups with blinding to obtain better data.