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Duloxetine response can vary in fibromyalgia patients based on subgroup classification
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Researchers found patients with fibromyalgia could be classified into one of several distinct subgroups based on three variables, which could in turn help guide individual patient management.
The researchers studied the results of four randomized, parallel, double-blind, placebo-controlled studies and identified 631 women with fibromyalgia (FM) who had received treatment with duloxetine for up to 12 weeks for analysis. Major depressive disorder (MDD) was present in 26.9% of the patients, and 47.4% had previously taken antidepressants.
Five groups of patient subtypes were identified. In cluster one, deemed the “worst’ cluster, patients reported high levels of pain and severe mental and physical impairment. Patients in cluster two reported high pain and physical impairment, and those in cluster three had moderate pain and high levels of mental impairment. Patients in cluster four reported moderate FM symptoms, whereas mean scores for those in cluster five were similar to results expected from the general population.
Clusters one (53.9%) and three (39.4%) had the highest scores for MDD at baseline. No significant differences in demographics were seen between the groups, according to the researchers.
At baseline, more than 80% of patients belonged to clusters one, two or three. After 12 weeks of treatment, 51.6% of patients in the duloxetine group were in categories 4 or 5 compared with 35.6% in the placebo group. Reduction of symptoms was most prevalent in patients original in subgroups one and three, according to the researchers. The proportion of patients in both groups was reduced from 64.8% to 37.5% in those treated with duloxetine vs. a reduction from 61.4% to 44.1% in the placebo group.
The results suggest further investigation in FM patient subgroups is needed to personalize the treatment of patients with FM, according to the researchers. – by Shirley Pulawski
Disclosure: Lipkovich was an employee of Eli Lilly at the time of manuscript preparation and finalization. Please see the full study for a list of all other authors’ relevant financial disclosures.
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