Rheumatology Medical News about Milnacipran, FMS, SNRI

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Milnacipran: A serotonin and norepinephrine reuptake inhibitor for the management of fibromyalgia syndrome
Formulary , 07/13/09

Cios DA et al. – Study reports that in patients with fibromyalgia syndrome (FMS) who are unable to tolerate first-line tricyclic antidepressant therapy, milnacipran may be a reasonable alternative or adjunct therapy.

Methods

Study reports the results of 3 randomized trials evaluating milnacipran in pts with FMS
All pts met the 1990 ACR classification criteria for FMS and were treatment-experienced
These trials assessed changes in composite FMS symptoms as measured by PED, morning-recall VAS pain scores, PGIC, and SF-36 PCS
Improvement was defined as:
- A ≥30% improvement from baseline in the PED morning-recall VAS pain score, a PGIC rating of "much improved" or "very much improved" at wk 15, and
- A ≥6-point improvement on the SF-36 PCS
Composite pain responders were defined as those who met the response criteria for changes in chronic pain

Results

Milnacipran has demonstrated efficacy in reducing FMS symptoms, with pts exhibiting response rates of 25% to 33%
Milnacipran is generally well tolerated and has minimal interactions with concomitant drug therapies
Nausea was the adverse event most frequently reported in clinical trials

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