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2015 ; 13
(ä): 27
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Preliminary experience using milnacipran in patients with juvenile fibromyalgia:
lessons from a clinical trial program
#MMPMID26112278
Arnold LM
; Bateman L
; Palmer RH
; Lin Y
Pediatr Rheumatol Online J
2015[Jun]; 13
(ä): 27
PMID26112278
show ga
BACKGROUND: There are no approved medications for juvenile fibromyalgia (JFM), a
disorder that is often under-diagnosed. The effects of milnacipran, a drug
approved for the management of fibromyalgia (FM) in adults, was assessed in a
clinical trial program for JFM. METHODS: Patients, ages 13-17 years who met the
Yunus and Masi criteria for JFM and/or 1990 American College of Rheumatology
criteria for FM, were enrolled in a responder-enriched, randomized withdrawal
trial. After receiving open-label milnacipran (8 weeks), patients with ?50 %
improvement in pain underwent double-blind randomization (1:2) to either placebo
or continuing treatment with milnacipran (8 weeks). All patients, including those
who did not meet the randomization criteria for double-blind withdrawal, were
allowed to enter an extension study with open-label milnacipran (up to 52 weeks).
The primary endpoint was loss of therapeutic response (LTR) during the
double-blind period. Additional outcome measures included the Patient Global
Impression of Severity (PGIS), Pediatric Quality of Life Inventory (PedsQL:
Generic Core Scales, Multidimensional Fatigue Scale), and Multidimensional
Anxiety Scale for Children (MASC). Safety assessments included adverse events
(AEs), vital signs, electrocardiograms, and laboratory tests. RESULTS: The
milnacipran program was terminated early due to low enrollment. Because only 20
patients were randomized into the double-blind withdrawal period, statistical
analyses were not conducted for the LTR endpoint. However, 116 patients entered
the open-label period of the initial study and 57 participated in the open-label
extension study. Their experience provides preliminary information about the use
of milnacipran in JFM patients. During both open-label periods, there were mean
improvements in pain severity, PGIC, PedsQL, and MASC scores. No unexpected
safety issues were detected. The most commonly reported treatment-emergent AEs
were nausea, headache, vomiting, and dizziness. Mean increases in heart rate and
blood pressure were observed, and were consistent with the AE profile in adults
with FM. CONCLUSIONS: The open-label findings provide preliminary evidence that
milnacipran may improve symptoms of JFM, with a safety and tolerability profile
that is consistent with the experience in adult FM patients. Future trial designs
for JFM should consider the relatively low recognition of this condition compared
to adult FM and the difficulties with enrollment. TRIAL REGISTRATION: NCT01328002
; NCT01331109.
|Adolescent
[MESH]
|Adrenergic Uptake Inhibitors/adverse effects/*therapeutic use
[MESH]
|Cyclopropanes/adverse effects/*therapeutic use
[MESH]