title: Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants.
abstract: OBJECTIVE
  To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs).
  
  
  METHODS
  Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n = 898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n = 898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods.
  
  
  RESULTS
  Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p < 0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p < 0.05). There were increases (p < 0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p < 0.05) in the pregabalin group vs TCAs in the pre-index ($9935 vs $8771) and follow-up ($10,689 vs $8379) periods.
  
  
  CONCLUSIONS
  Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin.
  
  
  CONCLUSIONS
  Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.
authors.affiliation: Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA. mgore@avalonhealthsolutions.com
authors.forename: Mugdha
authors.initials: M
authors.lastname: Gore
authors.forename: Kei-Sing
authors.initials: KS
authors.lastname: Tai
authors.forename: Arthi
authors.initials: A
authors.lastname: Chandran
authors.forename: Gergana
authors.initials: G
authors.lastname: Zlateva
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D015897:Comorbidity; D016208:Databases, Factual; D004358:Drug Therapy; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy* / Q000503:physiopathology*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin; D012189:Retrospective Studies; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid