Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Milnacipran for Treatment of Fibromyalgia: A Review of Clinial Trials

Milnacipran의 섬유근통 증후군치료에 대한 연구 검토

  • Lee, Kyung-Eun (Boston Medical Center, One Boston Medial Center Place)
  • Received : 2010.10.08
  • Accepted : 2010.11.04
  • Published : 2010.12.31
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Abstract

섬유근통 증후군은 만성 전신 통증을 나타내며 피곤, 두통, 우울증, 수면장애 등을 동반하는 질환이다. 주로 30-50대의 여성에게서 많이 나타나며 미국에서 2-4%, 한국에서 2%의 발병률을 보이고 있다. 정확한 원인과 기전이 밝혀져 있지 않아서 진단과 치료에 많은 논란과 어려움이 있다. 현재는 증상치료에 목표를 두고 삼환계항우울약을 많이 사용하고 있으나 심각한 부작용의 문제가 있다. 이러한 문제 때문에 최근에는 selective serotonin reuptake inhibitor (SSRI) 또는 serotonin-norepinephrine reuptake inhibitor (SNRI)를 빈번히 사용하고 있다. 본 연구는 SNRI의 하나인 milnacipran의 섬유근통 증후군 치료에 대한 효능 및 안정성을 알아보기 위해, MEDLINE에 등재된 논문을 기한없이 milnacipran과 fibromyalgia로 검색하여 무작위 배정 및 이중맹검 임상연구자료들을 선별하였다. 선별된 6개의 임상연구 결과, milnacipran를 사용했을 때 일관된 효능성과 안정성이 관찰되었고 섬유근통증후군 치료와 그에 수반되는 여러증상에 효과적인 것으로 나타났다.

Keywords

References

  1. American College of Rheumatology. Patient education for fibromyalgia. www.rheumatology.org/public/factsheets/diseases_and_conditions/fibromyalgia.asp?aud=pat (accessed July 25, 2010).
  2. Wolfe F, Ross K, Anderson J, et al., The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38: 19-28. https://doi.org/10.1002/art.1780380104
  3. Kim SH, Bae GR, Lim HS. Prevalence and risk factors of fibromyalgia syndrome and chronic widespread pain in two communities in Korea - First report in Korean. J Korean Rheumatism Assoc 2006; 13: 18-25.
  4. Wolfe F, Ross K, Anderson J, et al., Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. J Rheumatol 1995; 22: 151-6.
  5. Navarro RP. Contemporary management strategies for fibromyalgia. Am J Manag Care 2009; 15: S197-218.
  6. WolfeF, Smythe H, Yunus M, et al., The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160-172. https://doi.org/10.1002/art.1780330203
  7. Bennett R. Fibromyalgia: present to future. CurrRheumatol Rep 2005; 7: 371-376. https://doi.org/10.1007/s11926-005-0022-y
  8. Abeles AM, Pillinger MH, Solitar BM, et al., Narrative review:the pathophysiology of fibromyalgia. Ann Intern Med 2007; 146: 726-734. https://doi.org/10.7326/0003-4819-146-10-200705150-00006
  9. Goldenberg DL. Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain. Best Pract Res ClinRheumatol 2007; 21: 499-511. https://doi.org/10.1016/j.berh.2007.02.012
  10. Abeles M, Solitar BM, Pillinger MH, et al., Update on fibromyalgia therapy. Am J Med 2008; 121: 555-561. https://doi.org/10.1016/j.amjmed.2008.02.036
  11. Savella. Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc; expires 2010 Dec 31 (accessed July 26, 2010).
  12. Forest Laboratories, Inc. Forest Laboratories, Inc. and Cypress Bioscience, Inc. announce commercial availability ofSavella. www.frx.com/news/ PressRelease. aspx/ (accessed July 26, 2010)
  13. Jones CK, Eastwood BJ, Need AB, et al., Analgesic effects of serotonergic, noradrenergic or dual reuptake inhibitors in the carrageenan test in rats: Evidence for synergism between serotonergic and noradrenergic reuptake inhibition. Neuropharmacology 2006; 51: 1172-1180. https://doi.org/10.1016/j.neuropharm.2006.08.005
  14. Obata H, Saito S, Koizuka S, et al., The monoamine-mediated antiallodynic effects ofintrathecally administered milnacipran, a serotonin noradrenaline reuptake inhibitor, in a rat model of neuropathic pain. AnesthAnalg 2005; 100: 1406-1410. https://doi.org/10.1213/01.ANE.0000149546.97299.A2
  15. Product information. Savella (milnacipran). New York, NY: Forest Pharmaceuticals, Inc., December 2009.
  16. Puozzo C. Lens S, Reh C, et al., Lack of interaction of milnacipran with the cytochrome P450 isoenzymes frequently involved in the metabolism of antidepressants. ClinPharmacokinet 2005; 44: 977-988. https://doi.org/10.2165/00003088-200544090-00007
  17. Puozzo C, Panconi E, Deprez D. Pharmacology and pharmacokinetics of milnacipran. IntClinPsychopharmacol 2002; 17(Suppl 1): S25-S35. https://doi.org/10.1097/00004850-200206001-00004
  18. Vaishnavi SN, Nemeroff CB, Plott SJ, et al., Milnacipran: A comparative analysis of human monoamine uptake and transporter binding affinity. Biol Psychiatry 2004; 55: 320-322. https://doi.org/10.1016/j.biopsych.2003.07.006
  19. Gendreau RM, Thorn MD, Gendreau JF, et al., Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol 2005; 32: 1975-1985.
  20. Clauw DJ, Mease P, Palmer RH, et al., Milnacipran for the treatment of fibromyalgia in adults: a 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clnical trial. ClinTher 2008; 30: 1988-2004. https://doi.org/10.1016/j.clinthera.2008.11.009
  21. Mease PJ, Clauw DJ, Gendreau RM, et al., The efficacy and safety of milnacipran for the treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial. J Rheumatol 2009; 36: 398-409. https://doi.org/10.3899/jrheum.080734
  22. Goldenberg DL, Clauw DJ, Palmer RH, et al., Durability of therapeutic response to milnacipran treatment for fibromyalgia. Results of a randomized, double-blind, monotherapy 6-month extension study. Pain Med 2010; 11: 180-194. https://doi.org/10.1111/j.1526-4637.2009.00755.x
  23. Arnold LM, Gendreau RM, Palmer RH, et al., Efficacy and safety of milnacipran 100 mg/day in patients with fibromyalgia: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2010; 62: 2745-2756. https://doi.org/10.1002/art.27559
  24. Branco JC, Zachrisson O, Perrot S, et al., A European multicenter randomized double-blind placebo-controlled monotherapy clinical trial of milnacipran in treatment of fibromyalgia. J Rheumaol 2010; 37: 851-9. https://doi.org/10.3899/jrheum.090884