Amitriptyline in treatment of fibromyalgia
Level of evidence: B
Amitriptyline likely decrease fibromyalgia-related pain and fatigue.
A systematic review and meta-analysis «Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Ope»1 suggested a decrease in fibromyalgia-related pain (SMD -0.27 which translates to about 13% decrease in pain). Furthermore, it suggested a likely larger impact on fatigue and sleep problems compared to other potential drug treatments.
We were not able to find estimates on specific adverse events. Anticholinergic harms like dry mouth, somnolence, and constipation are the most likely adverse events «Brueckle MS, Thomas ET, Seide SE, et al. Amitriptyline's anticholinergic adverse drug reactions-A systematic multiple-indication review and meta-analysis. PLoS One 2023;18(4):e0284168 »2.
We downgraded the evidence certainty due to study limitations.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Ope»1 | SR/MA | Adults with fibromyalgia | Amitriptyline vs placebo or other medications | Pain, quality of life, fatigue, depression | moderate |
| Reference | Comments |
|---|---|
| «Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Ope»1 | High dropout rates. Very small trials. 9/10 trials over 20 years old. |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean change from baseline (sd) I | Mean at follow up C | Std. mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: moderate The quality of evidence is downgraded due to study limitations. *We used the weighted average standard deviation to estimate the mean difference | |||||
| «Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Ope»1 | 10 studies (291/254) | 9-24 weeks | - | - | -0,27 (-0,32 to -0,21) Estimated MD 0,74* Estimated relative decrease -13.5% |
References
- Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2022;5(5):e2212939 «PMID: 35587348»PubMed
- Brueckle MS, Thomas ET, Seide SE, et al. Amitriptyline's anticholinergic adverse drug reactions-A systematic multiple-indication review and meta-analysis. PLoS One 2023;18(4):e0284168 «PMID: 37018325»PubMed