Real-world role of tricyclic antidepressants in the treatment of fibromyalgia

Pain Practice, 04/24/2012

Research covering 1999 to 2005 using the same methods found that 15.9% of patients with fibromyalgia (FM) used tricyclic antidepressants (TCAs) during the year before FM diagnosis and 20.7% used TCAs during the year after. These findings suggest that TCA use among the patients with FM is uncommon and may be declining in real–world practice.

Methods

  • Using privately insured U.S. administrative claims data, this study examined TCA use for newly diagnosed FM patients.
  • Patients ages 18 to 64 years with ≥ 2 FM diagnoses (ICD–9–CM: 729.1) during Q1:2007 to Q1:2009, no previous FM diagnosis, and continuous eligibility for insurance during the year before and after the first FM diagnosis (“study period”) were identified as newly diagnosed (N = 10,129).
  • Treatment with TCAs was examined over the first treatment episode (allowing up to a 45–day gap between refills).
  • A sensitivity analysis was performed excluding patients with depression/anxiety diagnoses during the study period.

Results

  • During the study period, 8.9% of patients with FM used TCAs at anytime, 5.0% used TCAs during the year before FM diagnosis, and 7.2% used TCAs during the year after.
  • The mean (median) duration of the first treatment episode was 150 (58) days.
  • During this episode, 84.0% used other medications concomitantly, with 60.3% using analgesics and 39.6% using other antidepressants.
  • Additionally, 60.8% augmented TCA use with other drugs, 61.8% switched to another drug at the end of their TCA episode, and 22.8% discontinued TCAs without switching.
  • Similar patterns were observed for the subset of patients with no depression or anxiety (N = 7,655).

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