REVIEW - Amitriptyline in the treatment of fibromyalgia: a systematic review of its efficacy

[Guest guest]

Rheumatology Advance Access originally published online on August 12, 2008

Rheumatology 2008 47(12):1741-1746; doi:10.1093/rheumatology/ken317

--------------------------------------------------------------------------------

REVIEWS

Amitriptyline in the treatment of fibromyalgia: a systematic review of

its efficacy

B. Nishishinya1,2,3, G. Urrútia1,4, B. Walitt5, A. 6, X.

Bonfill1,4, C. Alegre6 and G. Darko5

1Iberoamerican Cochrane Center, Public Health and Clinical

Epidemiology Service, Hospital de la Santa Creu i Sant Pau,

Universitat Autònoma de Barcelona, 2Universitat Autònoma de Barcelona,

Barcelona, 3Kovacs Foundation, Palma de Mallorca, 4CIBER Epidemiología

y Salud Pública (CIBERESP), Spain, 5Washington Hospital Center, WA,

USA and 6Hospital de la Vall d'Hebron, Barcelona, Spain.

Abstract

The objective of this study was to assess the efficacy and safety of

amitriptyline as a treatment of FM. A comprehensive computerized

search in Medline (Pubmed), EMBASE and The Cochrane Library was

performed. Randomized controlled trials (RCTs) comparing amitriptyline

vs placebo in adult patients suffering from FM were identified, the

methodological quality was assessed and the results of the main

outcomes were evaluated. Ten RCTs were identified. Large clinical

variability and statistical heterogeneity precluded quantitative

meta-analysis. Overall, the study quality was moderate to high.

Amitriptyline 25 mg/day (six RCTs) demonstrated a therapeutic response

compared with placebo in the domains of pain, sleep, fatigue and

overall patient and investigator impression. This benefit was

generally seen at 6–8 weeks of treatment but no effect was noted at 12

weeks. Amitriptyline 50 mg/day (four RCTs) did not demonstrate a

therapeutic effect compared with placebo. Neither dose of

amitriptyline had an effect on tender points count. No clear

statements on adverse events with amitriptyline can be made due to

inconsistencies in data among the studies. A definitive clinical

recommendation regarding the efficacy of amitriptyline for FM symptoms

cannot be made. There is some evidence to support the short-term

efficacy of amitriptyline 25 mg/day in FM. There is no evidence to

support the efficacy of amitriptyline at higher doses or for periods

>8 weeks. More stringent RCTs with longer follow-up periods are

required to determine the long-term efficacy and safety of the

amitriptyline and define its role in the multidisciplinary management

of FM.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/12/1741?etoc

Not an MD