Abstract
BackgroundDuloxetine and amitriptyline are antidepressants used in the treatment of fibromyalgia. In published systematic reviews, there is no agreement about which drug is more effective and safer. This study aimed to compare evidence of the efficacy and safety of duloxetine compared with amitriptyline in the treatment of adult patients with fibromyalgia. This work contributes to guiding clinicians on the use of duloxetine or amitriptyline for the treatment of fibromyalgia and provides information for public health decision-makers.MethodsOverview of systematic reviews of clinical trials comparing duloxetine and amitriptyline in the treatment of fibromyalgia. The reviews were screened in Cochrane, PubMed, EMBASE, and SRDR with no restrictions on language and year of publication, considering that the research was conducted in July 2018 and updated until May 2020. The selection was based on the following criteria: adult patients with a diagnosis of fibromyalgia treated with duloxetine or amitriptyline, comparing the efficacy and safety in pain, fatigue, sleep, and mood disorder symptoms and quality of life, in addition to the acceptability of these antidepressants. The methodological quality and strength of evidence were assessed using the AMSTAR and GRADE instruments.ResultsEight systematic reviews were selected. Amitriptyline had low evidence for pain, moderate evidence for sleep and fatigue, and high evidence for quality of life. Duloxetine had high quality of evidence in patients with mood disorders. With low evidence, duloxetine has higher acceptability, but is safer in older patients, while amitriptyline is safer for non-elderly individuals.ConclusionBoth antidepressants are effective in the treatment of fibromyalgia, differing according to the patient’s symptoms and profile.RegistrationPROSPERO: CRD42019116101.
Highlights
Duloxetine and amitriptyline are antidepressants used in the treatment of fibromyalgia
A systematic review must be conducted when there are no reviews with the same objective or when the existing ones are outdated [16]. This overview summarized the results of eight systematic reviews on efficacy, safety and acceptability of duloxetine in the treatment of adult patients diagnosed with fibromyalgia, compared with amitriptyline
The evidence was considered of low quality in the GRADE analysis, and it should be emphasized that four reviews [6, 20, 22, 23] did not find a significant difference between the two drugs used in the management of this symptom
Summary
Duloxetine and amitriptyline are antidepressants used in the treatment of fibromyalgia. This study aimed to compare evidence of the efficacy and safety of duloxetine compared with amitriptyline in the treatment of adult patients with fibromyalgia. This work contributes to guiding clinicians on the use of duloxetine or amitriptyline for the treatment of fibromyalgia and provides information for public health decision-makers. Fibromyalgia is a syndrome whose etiology is still not fully understood. It is multifactorial and is characterized by chronic, widespread, diffuse musculoskeletal pain, often associated with fatigue, sleep and mood disorders, and a consequent adverse impact on the quality of life. The global prevalence of fibromyalgia is 2.7%, ranging from 0.4% in Greece to 9.3% in Tunisia. In Brazil, a study by Senna et al [3] recorded a 2.5% prevalence of the disease, affecting women in more than 90% of cases
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
