Secretaria de Estado da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Universidade Federal do Rio Grande do Sul - Faculdade de Farmácia - Programa de Pós-Graduação em Assistência Farmacêutica, Porto Alegre, RS, Brasil.
Adv Rheumatol. 2020 Jul 8;60(1):35. doi: 10.1186/s42358-020-00137-5.
Duloxetine 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.
Overview 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.
Eight 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.
Both antidepressants are effective in the treatment of fibromyalgia, differing according to the patient's symptoms and profile.
PROSPERO: CRD42019116101.
度洛西汀和阿米替林是用于治疗纤维肌痛的抗抑郁药。在已发表的系统评价中，关于哪种药物更有效和更安全尚无共识。本研究旨在比较度洛西汀与阿米替林治疗成人纤维肌痛患者的疗效和安全性证据。这项工作有助于指导临床医生选择度洛西汀或阿米替林治疗纤维肌痛，并为公共卫生决策者提供信息。
对比较度洛西汀和阿米替林治疗纤维肌痛的临床试验进行系统评价综述。在 Cochrane、PubMed、EMBASE 和 SRDR 中进行综述筛选，不限制语言和发表年份，考虑到研究于 2018 年 7 月进行，并更新至 2020 年 5 月。选择基于以下标准：接受度洛西汀或阿米替林治疗的纤维肌痛诊断为成人患者，比较疼痛、疲劳、睡眠和情绪障碍症状以及生活质量的疗效和安全性，以及这些抗抑郁药的可接受性。使用 AMSTAR 和 GRADE 工具评估方法学质量和证据强度。
选择了 8 篇系统评价。阿米替林在疼痛方面的证据质量低，在睡眠和疲劳方面的证据质量中等，在生活质量方面的证据质量高。度洛西汀在情绪障碍患者中具有高质量的证据。度洛西汀的可接受性更高，但在老年患者中更安全，而阿米替林在非老年患者中更安全，但其证据质量较低。
这两种抗抑郁药在治疗纤维肌痛方面均有效，但其疗效因患者的症状和特征而异。
PROSPERO：CRD42019116101。
