Recently, a study investigated the claims made by South Carolina health insurance which showed that fibromyalgia patients choose combination therapies over monotherapies. However, the combination therapies are more expensive.

According to researchers, it might be possible through results to find out the strength of patients' belief that combination therapies do a better job. They even stated that patients might stick with combos better because they reduce side effects. But, further studies are needed to confirm this evidence.

The study, “Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators,” was published in the journal Pain Practice.

The investigators from the University of Florida and the Medical University of South Carolina estimated the following four treatments: Pregabalin, Duloxetine, Milnacipran, and Venlafaxine.

Earlier studies evaluated that combination of Duloxetine, Milnacipran or Venlafaxine with Pregabalin lead to better patient’s outcomes, but there was no real-world data on how patients stick with treatments.

The research team examined about 100 records of fibromyalgia patients, on combination treatments, 655 on Pregabalin alone, 713 on Duloxetine alone, 131 on Milnacipran alone, and 272 on Venlafaxine alone. It was observed that 60% of the patients had muscle pain. Nervousness, fatigue, abdominal pain, headache, and insomnia were the other problems associated with fibromyalgia. Depression, irritable bowel syndrome, muscle weakness, and cognitive problems were seen in less than 5% of the patients.

Approximately half the group suffered from two or more fibromyalgia symptoms. Only 36% had one symptom. A large number of patients had other drugs besides the four included in the analysis. 58% used opioids, 47% used NSAIDs, and 39% used benzodiazepines. Muscle relaxants, antidepressants, tramadol, and sedatives were the other common medicines in use.

Patients did a safer job of adhering to combination therapies. The probability of patients' sticking with a combo [selective serotonin-norepinephrine reuptake inhibitor (SNRI) like Duloxetine, Milnacipran or Venlafaxine] was found to be 39 percent higher than the probability of patient sticking with Duloxetine alone. Patients were 69% more prone to stick with a combo involving Milanicipram than Milnacipram alone. Patients were 115% more prone to combo involving Venlafaxine than Venlafaxine solely. 

The cost of combo medication was higher than the cost of any of the four drugs alone as per the records of the insurer.

According to the researchers, the tendency of the combo users to stick with their treatment could bring about indirect economic benefits. It could lower rates of absenteeism and yields better productivity.

 There is a need to conduct further studies that follow patients over time, to better understand if a patient's tendency towards sticking with treatment can generate a better disease outcome.