Friday, 19 Jan 2018

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High Drug Discontinuations and Nonadherence in Fibromyalgia

Compliance and adherence was shown to be quite poor in fibromyalgia (FM) patients, with high rates of drug discontinuation and greater than 60% demonstrated low adherence.

Using claims data from a  large, Israeli, health maintenance organization 3922 FM were assessed from 2008 through 2011; specifically looking at the following agents over a 12 month period: pregabalin, antidepressants [selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)], and tricyclic antidepressants (TCA).

The proportion of days covered (PDC) was used as a measure of drug adherence. A PDC < 20% was considered low adherence and PDC ≥ 80% was considered high adherence. 

Of the 56.1% issued a qualifying prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis.

The 1-year drug discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%).

Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC ≥ 80%).

FM management may be confounded and complicated by high drug discontinuations and low adherence.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

These patients are doing the right thing! These meds are adjunctive at best and are not cost effective in terms of money or side effects. The biopsychosocial model of this disorder is the basis for treatment with non-pharmacologic therapies. Since there are no "big bucks" involved with non-pharmacologic treatment, the traditional medical model is a poor substitute that is costly and ineffective. I often have to tell patients that there is no medicine on the planet earth to put between their lips for the pain of fibromyalgia A good rheumatologist screens for medical conditions, provides cognitive therapy and guidance and validation and follows the patient for at least a year in case something changes. A bad rheumatologist diagnoses sero-negative RA and starts Remicade infusions! Medicalization of Misery as Dr. Norton Hadler has written about.

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