What is the role of quetiapine in fibromyalgia?
DOI:
https://doi.org/10.32385/rpmgf.v38i3.13178Keywords:
Fibromyalgia, Antipsychotics, Quetiapine, Rheumatology, Chronic painAbstract
Introduction: Fibromyalgia is a chronic rheumatological syndrome, of unknown aetiology, defined as widespread pain and a multiplicity of symptoms. Its treatment remains an important challenge. Some antipsychotic drugs, such as quetiapine, have been studied and used in this syndrome as adjunctive therapy. However, there is still controversy regarding their effectiveness and safety. The aim of this paper was to assess the efficacy, tolerability, and safety of quetiapine in adults with fibromyalgia.
Methods: The articles were obtained through bibliographic research on different scientific platforms using the MeSH terms ‘quetiapine’ and ‘fibromyalgia’. Studies were included according to the following PICOS model criteria: (P) adults diagnosed with fibromyalgia; (I) therapeutic plan using quetiapine; (C) placebo or another type of comparator; (O) symptom relief and tolerability and safety profiles; (S) systematic reviews and randomized controlled clinical trials. The Strength of Recommendation Taxonomy scale from the American Academy of Family Physicians was used to assess levels of evidence and to assign the strength of recommendation.
Results: From the 66 articles initially found, three randomized controlled trials were included. Although most studies reported somewhat heterogeneous and inconsistent results, they seem to present some advantages in symptom control with quetiapine. However, there is no robust evidence to prove an unequivocal benefit. The authors reported good tolerance and the absence of severe adverse effects with its use.
Conclusions: Current evidence is of poor quality, non-bias free, and difficult to generalize, despite being apparently favourable to some symptom relief in patients with fibromyalgia (strength of recommendation B). This positive profile is not supported by statistical significance. Adverse effects may limit its clinical usefulness. New studies with more specific, clear, and consensual structures and methodology are needed in order to reach quality conclusions.
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References
Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, et al. Fibromyalgia syndrome module at OMERACT 9: domain construct. J Rheumatol. 2009;36(10):2318-29.
Chong YY, Ng BY. Clinical aspects and management of fibromyalgia syndrome. Ann Acad Med Singap. 2009;38(11):967-73.
Branco JC. State-of-the-art on fibromyalgia mechanism. Acta Reumatol Port. 2010;35(1):10-5.
Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep. 2013;17(8):356.
Branco JC, Rodrigues AM, Gouveia N, Eusébio M, Ramiro S, Machado PM, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt – a national health survey. RMD Open. 2016;2(1):e000166.
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-10.
Sommer C, Häuser W, Burgmer M, Engelhardt R, Gerhold K, Petzke F, et al. Ätiologie und pathophysiologie des fibromyalgiesyndroms [Etiology and pathophysiology of fibromyalgia syndrome]. Schmerz. 2012;26(3):259-67. German
Markkula RA, Kalso EA, Kaprio JA. Predictors of fibromyalgia: a population-based twin cohort study. BMC Musculoskelet Disord. 2016;17:29.
Arnold LM, Fan J, Russell IJ, Yunus MB, Khan MA, Kushner I, et al. The fibromyalgia family study: a genome-wide linkage scan study. Arthritis Rheum. 2013;65(4):1122-8.
Lee YH, Choi SJ, Ji JD, Song GG. Candidate gene studies of fibromyalgia: a systematic review and meta-analysis. Rheumatol Int. 2012;32(2):417-26.
Mork PJ, Vasseljen O, Nilsen TI. Association between physical exercise, body mass index, and risk of fibromyalgia: longitudinal data from the Norwegian Nord-Trøndelag Health Study. Arthritis Care Res. 2010;62(5):611-7.
Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64(1):281-4.
Häuser W, Kosseva M, Üceyler N, Klose P, Sommer C. Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis. Arthritis Care Res. 2011;63(6):808-20.
Häuser W, Galek A, Erbslöh-Möller B, Köllner V, Kühn-Becker H, Langhorst J, et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain. 2013;154(8):1216-23.
Choi CJ, Knutsen R, Oda K, Fraser GE, Knutsen SF. The association between incident self-reported fibromyalgia and nonpsychiatric factors: 25-years follow-up of the Adventist Health Study. J Pain. 2010;11(10):994-1003.
Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55.
Lange M, Petermann F. Einfluss von depression auf das fibromyalgiesyndrom: eine systematische literaturanalyse [Influence of depression on fibromyalgia: a systematic review]. Schmerz. 2010;24(4):326-33. German
Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154(11):2310-6.
Üçeyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain. 2013;136(Pt 6):1857-67.
Rosado ML, Pereira JP, Fonseca JP, Branco JC. Adaptação cultural e validação do Fibromyalgia Impact Questionnaire - versão portuguesa [Cultural adaptation and validation of the Fibromyalgia Impact Questionnaire - Portuguese version]. Acta Reumatol Port. 2006;31(2):157-65. Portuguese
Marques AP, Santos AM, Assumpção A, Matsutani LA, Lage LV, Pereira CA. Validação da versão brasileira do Fibromyalgia Impact Questionnaire (FIQ) [Validation of the brazilian version of the Fibromyalgia Impact Questionnaire (FIQ)]. Rev Bras Reumatol. 2006;46(1):24-31. Portuguese
Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire: development and validation. J Rheumatol. 1991;18(5):728-33.
Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics, and uses. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S154-62.
Dunkl PR, Taylor AG, McConnell GG, Alfano AP, Conaway MR. Responsiveness of fibromyalgia clinical trial outcome measures. J Rheumatol. 2000;27(11):2683-91.
Bennett RM, Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. Minimal clinically important difference in the Fibromyalgia Impact Questionnaire. J Rheumatol. 2009;36(6):1304-11.
Offenbächer M, Cieza A, Brockow T, Amann E, Kollerits B, Stucki G. Are the contents of treatment outcomes in fibromyalgia trials represented in the International Classification of Functioning, Disability, and Health? Clin J Pain. 2007;23(8):691-701.
Lipkovich IA, Choy EH, Van Wambeke P, Deberdt W, Sagman D. Typology of patients with fibromyalgia: cluster analysis of duloxetine study patients. BMC Musculoskelet Disord. 2014;15:450.
Direção-Geral da Saúde. Abordagem diagnóstica da fibromialgia: norma nº 017/2016, de 27/12/2016, atualizada a 13/07/2017. Lisboa: DGS; 2017.
Domingues ME, Branco JC. Viver com fibromialgia: a visão da doente e do médico. Lisboa: Gradiva; 2008. ISBN 9789896162467
Eich W, Häuser W, Arnold B, Bernardy K, Brückle W, Eidmann U, et al. Das fibromyalgiesyndrom: allgemeine behandlungsgrundsätze, versorgungskoordination und patientenschulung [Fibromyalgia syndrome: general principles and coordination of clinical care and patient education]. Schmerz. 2012;26(3):268-75. German
Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 2013;18(3):119-26.
Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy or chronic pain. Cochrane Database Syst Rev. 2014;(1):CD007115.
Üçeyler N, Sommer C, Walitt B, Häuser W. Anticonvulsants for fibromyalgia. Cochrane Database Systc Rev. 2013;(10):CD010782.
Moore RA, Straube S, Aldington D. Pain measures and cut-offs: ‘no worse than mild pain’ as a simple, universal outcome. Anaesthesia. 2013;68(4):400-12.
Moore A, Derry S, Eccleston C, Kalso E. Expect analgesic failure: pursue analgesic success. BMJ. 2013;346:f2690.
Kalso E, Aldington DJ, Moore RA. Drugs for neuropathic pain. BMJ. 2013;347:f7339.
Ammar G, Naja WJ, Pelissolo A. Troubles anxieux résistants: revue des stratégies de traitements médicamenteux [Treatment-resistant anxiety disorders: a literature review of drug therapy strategies]. Encephale. 2015;41(3):260-5. French
Edwards SJ, Hamilton V, Nherera L, Trevor N. Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation. Health Technol Assess. 2013;17(54):1-190.
Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of posttraumatic stress disorder. Clin Neuropharmacol. 2013;36(6):216-22.
Kleinstäuber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacological interventions for somatoform disorders in adults. Cochrane Database Syst Rev. 2014;(11):CD010628.
Galek A, Erbslöh-Möller B, Köllner V, Kühn-Becker H, Langhorst J, Petermann F, et al. Psychische störungen beim fibromyalgiesyndrom: screening in einrichtungen verschiedener fachrichtungen [Mental disorders in patients with fibromyalgia syndrome: screening in centres of different medical specialties]. Schmerz. 2013;27(3):296-304. German
Rico-Villademoros F, Calandre EP, Slim M. Current status of atypical antipsychotics for the treatment of fibromyalgia. Drugs Today. 2014;50(6):435-44.
Seidel S, Aigner M, Ossege M, Pernicka E, Wildner B, Sycha T. Antipsychotics for acute and chronic pain in adults. Cochrane Database Syst Rev. 2013;(8):CD004844.
Ichikawa J, Li Z, Dai J, Meltzer HY. Atypical antipsychotic drugs, quetiapine, iloperidone, and melperone, preferentially increase dopamine and acetylcholine release in rat medial prefrontal cortex: role of 5-HT1A receptor agonism. Brain Res. 2002;956(2):349-57.
Jensen NH, Rodriguiz RM, Caron MG, Wetsel WC, Rothman RB, Roth BL. N-desalkylquetiapine, a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist, as a putative mediator of quetiapine’s antidepressant activity. Neuropsychopharmacology. 2008;33(10):2303-12.
Weisler RH, Montgomery SA, Earley WR, Szamosi J, Lazarus A. Efficacy of extended release quetiapine fumarate monotherapy in patients with major depressive disorder: a pooled analysis of two 6-week, double-blind, placebo-controlled studies. Int Clin Psychopharmacol. 2012;27(1):27-39.
Liebowitz M, Lam RW, Lepola U, Datto C, Sweitzer D, Eriksson H. Efficacy and tolerability of extended release quetiapine fumarate monotherapy as maintenance treatment of major depressive disorder: a randomized, placebo-controlled trial. Depress Anxiety. 2010;27(10):964-76.
Katila H, Mezhebovsky I, Mulroy A, Berggren L, Eriksson H, Earley W, et al. Randomized, double-blind study of the efficacy and tolerability of extended release quetiapine fumarate (quetiapine XR) monotherapy in elderly patients with major depressive disorder. Am J Geriatr Psychiatry. 2013;21(8):769-84.
Calandre EP, Rico-Villademoros F. The role of antipsychotics in the management of fibromyalgia. CNS Drugs. 2012;26(2):135-53.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548-56.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-6.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction — GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383-94.
McIntyre A, Paisley D, Kouassi E, Gendron A. Quetiapine fumarate extended-release for the treatment of major depression with comorbid fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. Arthritis Rheum. 2014;66(2):451-61.
Calandre EP, Rico-Villademoros F, Galán J, Molina-Barea R, Vilchez JS, Rodriguez-Lopez CM, et al. Quetiapine extended-release (Seroquel-XR) versus amitriptyline monotherapy for treating patients with fibromyalgia: a 16-week, randomized, flexible-dose, open-label trial. Psychopharmacology. 2014;231(12):2525-31.
Potvin S, Morin M, Cloutier C, Gendron A, Bissonnette A, Marchand S. Add-on treatment of quetiapine for fibromyalgia: a pilot, randomized, double-blind, placebo-controlled 12-week trial. J Clin Psychopharmacol. 2012;32(5):684-7.
Ventriglio A, Gentile A, Stella E, Bellomo A. Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Front Neurosci. 2015;9:297.
Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408.
Zhou X, Keitner GI, Qin B, Ravindran AV, Bauer M, Del Giovane C, et al. Atypical antipsychotic augmentation for treatment-resistant depression: a systematic review and network meta-analysis. Int J Neuropsychopharmacol. 2015;18(11):pyv060.
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