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Effectiveness and adverse effects of the use of mirtazapine as compared to duloxetine for fibromyalgia: real-life data from a retrospective cohort

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Abstract

On the background of a restricted armamentarium of drugs available for the management of fibromyalgia (FM), we aimed to compare the real-world effectiveness of two serotonin-norepinephrine reuptake inhibitors (SNRIs), mirtazapine (MTZ) and duloxetine (DLX) in FM. A medical records review was done to identify patients diagnosed with FM and prescribed a stable dose of either MTZ or DLX for more than 6 months. Their present status was determined by a telephonic interview which included a subjective assessment of improvement (Likert scale), FIQR (Revised Fibromyalgia Impact Questionnaire), adverse drug effects and compliance. One-fifty-eight patients were screened to include 81 patients [mean age 46.7 (± 13.0) years, 64 (79%) females]. Sixty (79%) had primary fibromyalgia and 66 (81.5%) were on DLX (20–40 mg) while 15(18.5%) were on MTZ (7.5 mg). In addition to the drugs, lifestyle modification was followed by 57 (70.3%). A moderate-to-good improvement was seen in 66 (81.5%), while 15 (18.5%) reported poor to no improvement overall. In the DLX group, a majority (59, 89.4%) showed moderate-to-good improvement compared to 7(46.7%) on MTZ [p = 0.001, 9.6(2.6–34)]. However, FIQR was similar for those on DLX (3.6 ± 0.9) and MTZ (3.8 ± 0.7). Adverse effects were reported for 51 (77%) of patients on DLX and all (100%) on MTZ with a poorer compliance with MTZ 5 (33.3%) compared to DLX 47 (71.2%) [p = 0.008, OR 0.1(0.03–0.4)]. On multivariate analysis, DLX use [OR 16.7 (95% CI 2.7–100); p = 0.008] and lifestyle modification [p = 0.002; OR 11.2(1.5–83.3)] were associated with better subjective outcomes. Low-dose MTZ appears to be inferior to DLX in the management of FM in this real-world cohort.

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Data will be available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, King George Medical University, Lucknow, India

    Pankti Mehta

  2. Kalinga Institute of Medical Sciences, Bhubaneswar, India

    Amartya Basu

  3. Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India

    Sakir Ahmed

Authors
  1. Pankti Mehta
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  2. Amartya Basu
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  3. Sakir Ahmed
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Contributions

All co-authors contributed substantially to the concept formulation and data analysis. PM drafted the manuscript and it was revised by all authors. All the three authors approve the final version of the manuscript and take full responsibility for all aspects of the work.

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Correspondence to Sakir Ahmed.

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Conflict of interest

SA has received honorarium as speaker from Pfizer, DrReddy’s, Cipla and Novartis (outside of the current work). The other authors declare no conflicts of interest.

Ethics approval

The study was approved by the Institutional Ethics Committee of Kalinga Institute of Medical Sciences vide letter no KIIT/KIMS/IEC/749/2021.

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Mehta, P., Basu, A. & Ahmed, S. Effectiveness and adverse effects of the use of mirtazapine as compared to duloxetine for fibromyalgia: real-life data from a retrospective cohort. Rheumatol Int 42, 1549–1554 (2022). https://doi.org/10.1007/s00296-022-05135-y

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