Canada’s Queen’s University scientist Ian Gilron has found a more effective way to treat fibromyalgia by combining Lyrica (pregabalin), an anticonvulsant drug, with Cymbalta (duloxetine), an antidepressant.
The study, “Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial,” was published in the journal Pain.
“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” Gilron said in a news release. “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”
Fibromyalgia is a clinical syndrome characterized by chronic widespread pain. Symptoms include sleep disturbance, depression, fatigue, and cognitive dysfunction.
“The condition affects about 1.5 to 5 percent of Canadians — more than twice as many women as men. It can have a devastating on the lives of patients and their families,” Gilron said. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”
Evidence supports a diverse array of treatments for fibromyalgia including exercise, pharmacological, physical, psychological, and other therapies. The anticonvulsant Lyrica and the antidepressant Cymbalta are two newer pharmacological therapies that are widely used to treat fibromyalgia. Lyrica and Cymbalta are thought to reduce pain by different pharmacological actions, thereby providing a mechanistic rationale for combining the two.
The new study compared a Lyrica-Cymbalta combination to each drug individually. Using a randomized, double-blind, four-period crossover design, 39 patients completed a treatment with maximally tolerated doses of a placebo; Lyrica alone; Cymbalta alone; and a Lyrica-Cymbalta combination, over a period of six weeks.
The trial’s primary endpoint was daily pain, and secondary outcomes included global pain relief, Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures.
The results suggested that combining Lyrica with Cymbalta can safely improve outcomes in fibromyalgia, including pain relief, physical function, and overall quality of life.
By identifying and studying promising drug combinations, research is showing how physicians can make the best use of current treatments available to patients. “The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to healthcare providers,” Gilron said.