Fibromyalgia Patients Stick with Combo Therapies Better Than Stand-alones, Study Reports

Fibromyalgia Patients Stick with Combo Therapies Better Than Stand-alones, Study Reports

Fibromyalgia patients stick with combination therapies better than stand-alone treatments, but the combo approaches are more expensive, according to a study that examined South Carolina health insurance claims.

The results could reflect patients’ belief that combination therapies do a better job, researchers said. They also said patients may stick with combos better because they reduce side effects. But to prove this, more studies are needed, they said.

The study, Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators,” was published in the journal Pain Practice.

Lyrica (pregabalin), Cymbalta (duloxetine), Savella (milnacipran), and Effexor (venlafaxine) were the four treatments that researchers from the University of Florida and the Medical University of South Carolina evaluated.

Earlier studies suggested that combining Cymbalta, Savella, or Effexor with Lyrica generated better patients outcomes, but there was no real-world data on how patients stick with treatments.

The research team looked at the records of 100 fibromyalgia patients on combination treatments, 655 patients on Lyrica alone, 713 on Cymbalta alone, 131 on Savella alone, and 272 on Effexor alone.

Sixty-percent of the patients had muscle pain. Other fibromyalgia-related problems were nervousness, fatigue, abdominal pain, headache, and insomnia. Each affected less than 22 percent of the group, however. Depression, irritable bowel syndrome, muscle weakness, and cognitive problems were seen in less than 5 percent of the patients.

Nearly half the group had two or more fibromyalgia symptoms. Only 36 percent had one symptom.

Many patients were taking other drugs besides the four included in the analysis. Fifty-eight percent used opioids, 47 percent NSAIDs, or nonsteroidal anti-inflammatory drugs, and 39 percent benzodiazepines. Other commonly used medications included muscle relaxants, antidepressants, tramadol, and sedatives.

Patients did a better job of sticking with combination therapies. The chance of a patient sticking with a combo that included a selective serotonin norepinephrine reuptake inhibitor (SNRI) like Cymbalta, Savella, or Effexor was 39 percent higher than the chance of the patient sticking with Cymbalta alone. Patients were 69 percent more likely to stick with a combo involving Savella than Savella alone, and 115 percent more likely to stay with a combo involving Effexor than Effexor alone.

The cost of combo medication was higher than the cost of any of the four drugs alone, according to records of the insurer, the South Carolina Blue Cross Blue Shield State Health Plan.

Combo users’ penchant for sticking with their treatment could yield indirect economic benefits, however, the researchers said. These include lower rates of absenteeism and better productivity.

To understand if a patient’s penchant for sticking with a treatment can generate a better disease outcome, researchers should do studies that follow patients over time, the team said.