Adherence to treatment is very poor among fibromyalgia (FM) patients, according to a study conducted in a real-life setting that was published in The Journal of Rheumatology. Only 9.3 percent of patients followed the prescribed treatment regimen for more than a year.
The study “Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization” was conducted by a team of researchers from Tel Aviv University, Israel. The study was supported by Pfizer.
About 2 to 5 percent of women worldwide are affected by FM. With no available cure for the condition, treatments are focused on preventing pain sensation, restoring sleep time, and improving overall physical functions.
Non-pharmacologic strategies such as exercise and cognitive-based therapies are commonly used, but many patients need pharmacological management of their symptoms.
The majority of the medicines prescribed for FM were designed to regulate how the brain and nerve cells interpret signals (neuromodulatory function). The most commonly used classes of drugs are tricyclic antidepressant (TCA) compounds, selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI) antidepressants, and the anticonvulsant Lyrica (pregabalin).
For FM patients, as for many others with chronic illnesses, adherence to therapy can be hard. Daily administration regimens and therapy intolerance are some of the factors contributing to non-adherence. But also social stigma, patient disbelief about therapies, and poor patient-doctor communication can increase the risk of nonadherence to medication.
Now, researchers evaluated therapy adherence and persistence in a group of 3,932 patients diagnosed with FM from 2008 and 2011, who were followed by the health maintenance organization Maccabi Healthcare Services in Israel.
About 41.2 percent of the patients had received a prescription for an FM medication in the year before diagnosis. Of the remaining patients, 56.1 percent were prescribed treatment within the first year after diagnosis, and 45 percent stopped taking at least one of the medications during that time period.
Within the first year after diagnosis, 59.1 percent of patients were prescribed TCA, 46.7 percent antidepressants (SSRI/SNRI), and 24.1 percent received Lyrica. Combination of therapies of different classes was rare in this population.
Researchers found that 79.3 percent of the patients who were prescribed for the first time after FM diagnosis discontinued therapy in the following year. After one year from therapy initiation with SSRI/SNRI antidepressants, TCA, or anti-epileptics, only 26.3%, 18.4%, and 9.0%, respectively, were still following treatment.
Anxiety and depression were psychological features that were 2.2 times more prevalent among patients who received treatment before FM diagnosis, compared to patients who were not receiving any FM medicines.
Among patients who were prescribed therapies, researchers found that the mean proportion of days covered by any therapy during one year was 26%. Indeed, 60.5% of the patients took the medicines during less than 20% of the days, and only 9.3% of the patients followed treatment regimen for more than 80% of the year.
Overall, these results show that “in an Israeli ‘real-life’ population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low,” the researchers wrote.
These findings are in line with previous studies, and further suggest that only a small minority of patients who achieve clinical therapeutic benefit with the prescribed therapies are willing to continue with these medications for intervals longer than a year.
“Our results clearly indicate that there is an urgent need for new therapies with improved effectiveness and better tolerability for patients with FM. Physicians should keep in mind the problematic characteristic of adherence when evaluating and treating patients with FM, so that physicians can intervene and reach out to those who are at higher risk of nonadherence.” the team concluded.
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