Longitudinal observation of treatment patterns and outcomes for patients with Fibromyalgia: 12-month findings from the REFLECTIONS study

Rebecca L. Robinson, Kurt Kroenke, David A. Williams, Philip Mease, Yi Chen, Douglas Faries, Xiaomei Peng, Danette Hann, Madelaine Wohlreich, Bill Mccarberg

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice. Design and Outcome Measures: Data from 1,700 patients were collected at baseline and 1, 3, 6, and 12 months. Repeated measures and Poisson regression models controlling for demographic, clinical, and baseline outcomes were used to assess changes in health outcomes (Brief Pain Inventory severity and interference, Sheehan Disability Scale, Fibromyalgia Impact Questionnaire), satisfaction, and economic factors for patients who initiated on pregabalin (214, 12.6%), duloxetine (264, 15.5%), milnacipran (134, 7.9%), or tricyclic antidepressants (66, 3.9%). Sensitivity analyses were run using propensity-matched cohorts. Results: Patients started on 145 unique drugs for fibromyalgia, and over 75% of patients took two or more medications concurrently for fibromyalgia at each time point assessed. Overall, patients showed improvement on the four health outcomes, with few differences across medication cohorts. At baseline, patients reported annual averages of 20.3 visits for outpatient care, 27.7 missed days of work, and 32.6 days of care by an unpaid caregiver. The duloxetine and milnacipran (vs pregabalin or tricyclic antidepressant) cohorts had fewer outpatient visits during the 12-month study. Patients reported satisfaction with overall treatment and their fibromyalgia medication (46.0% and 42.8%, respectively). Conclusions: In this real-world setting, patients with fibromyalgia reported modest improvements, high resource, and medication use, and were satisfied with the care they received. Cohort differences were difficult to discern because of the high rates of drug discontinuation and concomitant medication use over the 12-month study period.

Original languageEnglish (US)
Pages (from-to)1400-1415
Number of pages16
JournalPain Medicine
Volume14
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Fibromyalgia
Observation
Tricyclic Antidepressive Agents
Health
Ambulatory Care
Patient Satisfaction
Pharmaceutical Preparations
Caregivers
Outpatients
Economics
Demography
Outcome Assessment (Health Care)
Pain
Equipment and Supplies

Keywords

  • Fibromyalgia
  • Longitudinal
  • Observational
  • Outcomes
  • Pharmacotherapy
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Longitudinal observation of treatment patterns and outcomes for patients with Fibromyalgia : 12-month findings from the REFLECTIONS study. / Robinson, Rebecca L.; Kroenke, Kurt; Williams, David A.; Mease, Philip; Chen, Yi; Faries, Douglas; Peng, Xiaomei; Hann, Danette; Wohlreich, Madelaine; Mccarberg, Bill.

In: Pain Medicine, Vol. 14, No. 9, 09.2013, p. 1400-1415.

Research output: Contribution to journalArticle

Robinson, RL, Kroenke, K, Williams, DA, Mease, P, Chen, Y, Faries, D, Peng, X, Hann, D, Wohlreich, M & Mccarberg, B 2013, 'Longitudinal observation of treatment patterns and outcomes for patients with Fibromyalgia: 12-month findings from the REFLECTIONS study', Pain Medicine, vol. 14, no. 9, pp. 1400-1415. https://doi.org/10.1111/pme.12168
Robinson, Rebecca L. ; Kroenke, Kurt ; Williams, David A. ; Mease, Philip ; Chen, Yi ; Faries, Douglas ; Peng, Xiaomei ; Hann, Danette ; Wohlreich, Madelaine ; Mccarberg, Bill. / Longitudinal observation of treatment patterns and outcomes for patients with Fibromyalgia : 12-month findings from the REFLECTIONS study. In: Pain Medicine. 2013 ; Vol. 14, No. 9. pp. 1400-1415.
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abstract = "Objective: To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice. Design and Outcome Measures: Data from 1,700 patients were collected at baseline and 1, 3, 6, and 12 months. Repeated measures and Poisson regression models controlling for demographic, clinical, and baseline outcomes were used to assess changes in health outcomes (Brief Pain Inventory severity and interference, Sheehan Disability Scale, Fibromyalgia Impact Questionnaire), satisfaction, and economic factors for patients who initiated on pregabalin (214, 12.6{\%}), duloxetine (264, 15.5{\%}), milnacipran (134, 7.9{\%}), or tricyclic antidepressants (66, 3.9{\%}). Sensitivity analyses were run using propensity-matched cohorts. Results: Patients started on 145 unique drugs for fibromyalgia, and over 75{\%} of patients took two or more medications concurrently for fibromyalgia at each time point assessed. Overall, patients showed improvement on the four health outcomes, with few differences across medication cohorts. At baseline, patients reported annual averages of 20.3 visits for outpatient care, 27.7 missed days of work, and 32.6 days of care by an unpaid caregiver. The duloxetine and milnacipran (vs pregabalin or tricyclic antidepressant) cohorts had fewer outpatient visits during the 12-month study. Patients reported satisfaction with overall treatment and their fibromyalgia medication (46.0{\%} and 42.8{\%}, respectively). Conclusions: In this real-world setting, patients with fibromyalgia reported modest improvements, high resource, and medication use, and were satisfied with the care they received. Cohort differences were difficult to discern because of the high rates of drug discontinuation and concomitant medication use over the 12-month study period.",
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AU - Mease, Philip

AU - Chen, Yi

AU - Faries, Douglas

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AB - Objective: To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice. Design and Outcome Measures: Data from 1,700 patients were collected at baseline and 1, 3, 6, and 12 months. Repeated measures and Poisson regression models controlling for demographic, clinical, and baseline outcomes were used to assess changes in health outcomes (Brief Pain Inventory severity and interference, Sheehan Disability Scale, Fibromyalgia Impact Questionnaire), satisfaction, and economic factors for patients who initiated on pregabalin (214, 12.6%), duloxetine (264, 15.5%), milnacipran (134, 7.9%), or tricyclic antidepressants (66, 3.9%). Sensitivity analyses were run using propensity-matched cohorts. Results: Patients started on 145 unique drugs for fibromyalgia, and over 75% of patients took two or more medications concurrently for fibromyalgia at each time point assessed. Overall, patients showed improvement on the four health outcomes, with few differences across medication cohorts. At baseline, patients reported annual averages of 20.3 visits for outpatient care, 27.7 missed days of work, and 32.6 days of care by an unpaid caregiver. The duloxetine and milnacipran (vs pregabalin or tricyclic antidepressant) cohorts had fewer outpatient visits during the 12-month study. Patients reported satisfaction with overall treatment and their fibromyalgia medication (46.0% and 42.8%, respectively). Conclusions: In this real-world setting, patients with fibromyalgia reported modest improvements, high resource, and medication use, and were satisfied with the care they received. Cohort differences were difficult to discern because of the high rates of drug discontinuation and concomitant medication use over the 12-month study period.

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