Fibromyalgia Patients Neglect Medical Treatment

In patients with new diagnoses of fibromyalgia, rates of prescription filling and treatment adherence are very low.

Rates of treatment adherence are even lower when fibromyalgia is combined with migraine headaches and anxiety.

Patients with fibromyalgia of higher socioeconomic status adhere to treatment better than those of lower economic means.

Although several neuromodulatory drugs are currently employed to improve sleep and physical function and alleviate pain in patients with fibromyalgia, Dana Ben-Ami Shor and colleagues in Israel pointed to a paucity of literature looking at patient acceptance and adherence to treatment regimens.

They sought to determine the adherence rates and persistence with fibromyalgia therapy and reported their findings in a recent Journal of Rheumatology article.

The study

The authors conducted a retrospective cohort study of data from a large Israeli health maintenance organization, including patients with a new diagnosis of fibromyalgia who received prescriptions for neuromodulatory medication.

The study included 3932 subjects. Fibromyalgia medications were prescribed to 1620 patients the year before diagnosis and to 1296 patients the year after diagnosis; 1636 patients did not receive prescriptions 1 year before or after diagnosis.

The results

• Patients to whom fibromyalgia medications were prescribed in the year preceding their diagnosis were older and more likely to be immigrants when compared with patients who did not receive prescriptions before diagnosis (p<0.001 and p=0.005, respectively).

• Patients with anxiety or depression or both before diagnosis were more likely to receive prescriptions for fibromyalgia before diagnosis (72.5% versus 32.8%; p<0.001).

• Of those to whom fibromyalgia medications were prescribed after diagnosis, more had baseline anxiety and depression, they were more likely to have received the diagnosis from a primary care physician, and they were less likely to receive the diagnosis while hospitalized (36.5% prescribed versus 28.1% nonprescribed patients [p < 0.001], 47.0% versus 39.7%, and 0.8% versus 6.4% [p < 0.001], respectively).

• Of the prescribed patients, 59.1% received a tricyclic antidepressant, 46.7% a serotonin or norepinephrine reuptake inhibitor antidepressant or both, and 24.1% an antiepileptic.

• A prescription was filled within 1 year of diagnosis by 80.3% (n = 1041) of the patients newly prescribed post-diagnosis.

• Of the 1041 patients with new diagnoses and prescriptions, 825 (79.3%) discontinued therapy during the year after the first filled prescription.

• Therapy was discontinued by 91.0% of patients prescribed tricyclic antidepressants.

• Therapy was discontinued by 73.7% of subjects prescribed serotonin/norepinephrine antidepressants.

• One-fifth (20.7%) of patients remained on any fibromyalgia medication after 1 year.

• Subjects of higher socioeconomic status and those with a diagnosis of anxiety, depression, or migraines were more likely to continue therapy.

• Even though high socioeconomic status was associated with a greater than 80% proportion of days covered, only 11.3% of them remained adherent to treatment.

Implications for physicians

• Fibromyalgia is a difficult condition to treat because of poor overall adherence to medical treatment.

• Patients with fibromyalgia should be monitored closely for adherence to prescribed treatment, with a particular focus on lower socioeconomic patients.

• Education and encouragement should be used to promote adherence.

• Primary care physicians are at greater risk for delayed diagnosis of fibromyalgia and should consider the diagnosis if considering prescribing fibromyalgia medications.

Disclosures:

Pfizer provided funding for this project.

References:

Ben-Ami Shor D, Weitzman D, Dahan S, et al. “Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization.” J Rheumatol. 2017 Oct;44(10):1499-1506. doi: 10.3899/jrheum.170098. Epub 2017 Aug 1.