Drug treatments for fibromyalgia: systematic review and network meta-analysis of randomised trials.
Dena Zeraatkar, João Pedro Lima, Sarah Kirsh et al.
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In 30 seconds
This systematic review and network meta-analysis compared drug treatments for fibromyalgia in adults, including evidence from 151 randomised trials involving 32 592 participants. Compared with placebo or usual care, low certainty evidence suggested that sodium oxybate, selective NRIs, SNRIs, and gabapentinoids increased the likelihood of meaningful patient-reported improvement or recovery by 105 to 283 more per 1000 patients. No drug showed pooled effects on pain, physical health, or mental health that met or exceeded thresholds for clinical importance. The authors concluded that several drug classes may offer typically small benefits in selected outcomes.
Key findings
- Meaningful improvement or recovery was 105 to 283 more per 1000 patients with sodium oxybate, selective NRIs, SNRIs, or gabapentinoids versus placebo or usual care; evidence certainty was low.
- Fibromyalgia impact questionnaire scores were lower with sodium oxybate (mean difference -8.81, 95% CI -11.78 to -5.84) and SSRIs (mean difference -8.02, 95% CI -13.40 to -2.64); evidence certainty was low.
- No drug showed pooled effects on pain, physical health, or mental health that met or exceeded thresholds for clinical importance.
- No drug increased the risk of treatment discontinuation or serious adverse events.
Why it matters
The review synthesises a large randomised-trial evidence base, but its findings suggest that benefits are limited and vary by outcome. In particular, improvements in selected measures should not be interpreted as evidence of clinically important average effects on pain or overall health. The low certainty of much of the evidence also matters when weighing potential benefits against treatment burden and patient priorities.
What to keep in mind
Evidence for the reported benefits was low certainty, and the review found no drug with pooled effects on pain, physical health, or mental health meeting clinical-importance thresholds.