Long-Term Use of FM Treatments

EP: 1.Introduction and Overview of FM

EP: 2.Why FM is Often Misunderstood

EP: 3.The Pathophysiology of FM

EP: 4.Genetics and Other Risk Factors for FM

EP: 5.Characteristics of FM

EP: 6.Factors that Affect FM Symptoms

EP: 7.The Challenges of Diagnosing FM

EP: 8.Comorbidities and FM

EP: 9.Who is Diagnosing FM

EP: 10.Treatment Options and Supportive Therapies for FM

EP: 11.Treating Patients With FM

EP: 12.NSAID for Treatment of FM

EP: 13.Off Label Drugs and FM

EP: 14.Milnacipran as Treatment for FM

EP: 15.Duloxetine and Pregabalin as Treatment for FM

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EP: 16.Long-Term Use of FM Treatments

EP: 17.Step Approach for FM Treatment

EP: 18.Combination Therapies and FM

EP: 19.Personalizing FM Treatment

EP: 20.Challenges and Unmet Needs in FM

EP: 21.Prospective Advancements and Final Thoughts on the Treatment of FM

Transcript

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: What do we know about the long-term use of milnacipran, duloxetine, pregabalin in patients with fibromyalgia? Is there any evidence of tolerance, adverse events improvement? Anything long-term that we know.

Daniel Clauw, MD: All the drugs to get approved had to have one year open labeled extension. We have that much data, but not more than a year. And even though it was only 1,000 or 1,500 patients that got exposed for a year. After that, it's just like the regular surveillance system, which is not very good at telling us if there are long-term adverse effects for people taking these drugs for decades.

Benjamin Natelson, MD: For lack of efficacy. That's another issue. I seem to remember, although I couldn't cite it, there was a paper that was talking about these treatments and having a relatively short I guess as you pointed out, Dan, they have to have worked for a year, what's your experience, Wendy and you also Dr Botsoglou on long term adverse effects.

Kostas Botsoglou, MD: I've seen tolerance with some of these patients where they've been on it for quite a while and they just keep getting more breakthrough pain and so forth but in terms of safety, I haven't seen any new safety signals, we are doing chemistries and kidney functions and liver functions in these patients routinely anyway. It's more the tolerance that's the issue.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I agree with you, and we've seen that for years with SSRIs and tolerance. Part of me wonders is the condition worsening and that's why they're feeling or are they developing a tolerance? Certainly, with opioids we start to see Hy Opioid hyperalgesia and that's a real issue as well. But I don't know of any safety issues when these products are used long term.

Transcript edited for clarity.