NEWS:Dopamine Agonist Improves Outcomes in Fibromyalgia

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Dopamine Agonist Improves Outcomes in Fibromyalgia

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 10 - A subset of patients with severe

fibromyalgia respond to the dopamine 3 receptor agonist pramipexole

with significant improvement in pain, fatigue and function, researchers

report.

" I suspect that this class of medication will transform the treatment

of fibromyalgia and also change the way we consider dopamine in its

pathogenesis, " Dr. J. Holman from Pacific Rheumatology

Associates, Renton, Washington told Reuters Health.

Dr. Holman and Robin R. Myers investigated the effects of pramipexole

in a 14-week randomized, double-blind trial involving 40 patients with

fibromyalgia. The participants were mostly white women; more than half

were on narcotics and a third were disabled by their condition.

" This was an unusual study design, because the most severely afflicted

patients were allowed to participate, " Dr. Holman commented.

Compared with subjects assigned to a placebo group, the pramipexole

group experienced significant reductions in pain, the authors report in

the August issue of Arthritis & Rheumatism, with 42% of the pramipexole

group achieving at least a 50% reduction in pain compared with 14% of

the placebo group.

" This is the highest response rate yet reported for a single medication

to treat fibromyalgia, " Dr. Holman said. He cited response rates of 29%

for pregabalin, 36% for milnacipran, and 30% for duloxetine in prior

studies.

Pramipexole-treated patients also experienced improvements in the

Fibromyalgia Impact Questionnaire total score, the pain improvement

scale, and function, fatigue, and global scores on the Multidimensional

Health Assessment Questionnaire, the report indicates.

Side effects included weight loss and increased anxiety in the

pramipexole group and weight gain in the placebo group, the researchers

note.

" The most important message here is that even severe fibromyalgia is

treatable, " Dr. Holman concluded. " As with most complex disorders, we

should not expect simple answers quite yet. Doses of effective

medications have to be carefully adjusted to get maximum results in

other disorders, and fibromyalgia is similar. "

He is planning a multicenter trial in " typical study patients, i.e.,

those not taking concomitant medication. "

Arthritis Rheum 2005;52:2495-2505.

http://www.medscape.com/viewarticle/510443