Comparative Efficacy and Tolerability of Quetiapine XR and Amitriptyline in the Treatment of Fibromyalgia

A Randomized, Pilot Clinical Trial to Assess the Comparative Efficacy and Tolerability of Quetiapine XR Versus Amitriptyline for the Treatment of Patients With Fibromyalgia

Quetiapine, a second generation antipsychotic, has shown beneficial activity on fibromyalgia symptomatology, administered as add-on treatment, in a sample of 35 patients. The purpose of the present study is to compare, in a controlled setting, the efficacy and the tolerability of quetiapine extended release with amitriptyline in the treatment of patients with fibromyalgia

Study Overview

• Status: Completed
• Conditions: Fibromyalgia
• Intervention / Treatment: Drug: amitriptyline; Drug: quetiapine

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Phase 4

Contacts and Locations

Study Locations

• Spain
  • Granada, Spain, 18012
    • Hospital Clinico Universitario San Cecilio

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 68 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Male or female patients aged 18 70 years.
2. Meeting American College of Rheumatology criteria for primary fibromyalgia: widespread aching pain in all four quadrants of the body and axial skeleton and greater than or equal to 11 of 18 tender points under digital palpation examination.
3. A FIQ total score (0 100) of 40 or greater
4. A score of 4 or greater on the average pain item of the BPI
5. Written informed consent
6. Female patients of childbearing potential must be using a reliable contraceptive method and have a negative urine human chorionic gonadotropin (HCG) test at enrolment.
7. Able to understand and comply with the requirements of the study.

Exclusion Criteria:

1. Evidence of current traumatic injury, inflammatory rheumatic disease, or infectious or endocrine related joint disease.
2. A lifetime history of hypomania, mania, psychosis or dementia.
3. Current primary Axis I diagnosis other than major depressive disorder
4. Substance or alcohol dependence at enrolment and within the past 12 months (except dependence in full remission, and except for caffeine or nicotine dependence), as defined by DSM IV
5. Severe depression as evidenced by a Beck Depression Inventory score ≥ 30
6. Patients who, in the opinion of the investigator, pose an imminent risk of suicide or a danger to self or others
7. History of seizures
8. Known lack of response to 2, or more than 2, different type of antidepressants in depression of fibromyalgia.
9. Pregnancy or breast feeding.
10. Patients with a history of urinary retention, angle closure glaucoma, or increased intraocular pressure.
11. Patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure or conduction abnormalities), cerebrovascular disease or conditions which would predispose patients to severe hypotension (dehydration, hypovolemia and treatment with antihypertensive medications).
12. Patients who have received IMAOs, SSRIs or other antidepressants within two weeks of randomization.
13. Current or past history of kidney or liver insufficiency
14. Prior to randomization. Unwillingness to discontinue previously prescribed drugs for fibromyalgia other than those authorized in the protocol, as acetaminophen and bromazepam
15. Patients who have received quetiapine or amitriptyline within 1 year of randomization.
16. Patients with known intolerance or lack of response to quetiapine fumarate and/or amitriptyline, as judged by the investigator
17. Use of any of the following cytochrome P450 3A4 inhibitors within 14 days of enrolment, including but not limited to: ketoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, troleandomycin, indinavir, nelfinavir, ritonavir, fluvoxamine, and saquinavir
18. Use of any of the following cytochrome P450 inducers within 14 days of enrolment, including but not limited to: phenytoin, carbamazepine, barbiturates, rifampin, St. John's wort, and glucocorticoids
19. Opiates, amphetamine, barbiturate, cocaine, cannabis, or hallucinogen abuse by DSM IV criteria within 4 weeks of enrolment
20. Medical conditions that would affect absorption, distribution, metabolism, or excretion of study treatment, with clinical relevance.
21. Unstable or inadequately treated medical illness (e.g. congestive heart failure, angina pectoris, hypertension), as judged by the investigator
22. Involvement in planning and conduct of the study
23. Previous enrolments or randomisation of treatment in the present study.
24. Participation in another trial with drugs within 4 weeks of enrolment into this study or a longer period in accordance with local requirements.
25. Patients with uncontrolled Diabetes Mellitus (DM)
26. An absolute neutrophil count (ANC) equal or lower than 1.5 x 109 per liter.
27. Patients who show at the randomization visit a reduction in the FIQ total score equal or greater than 20% from the screening visit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: quetiapine	Drug: quetiapine; initial dose: 50 mg/day, target dose: 100 mg/day, maximum dose: 300 mg/day, dosage form:extended release tablets , duration: 16 weeks; Other Names: Seroquel XR
Active Comparator: amitriptyline	Drug: amitriptyline; initial dose 10 mg/day, target dose: 25 mg/day, maximum dose: 75 mg/day, dosage form: tablets, duration: 16 weeks; Other Names: Tryptizol

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Mean change from baseline to endpoint in the total score of Fibromyalgia Impact Questionnaire	baseline, 4, 8, 12 and 16 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Change from baseline to endpoint in the scores of the Brief Pain Inventory, the Pittsburgh Sleep Quality Inventory, the Beck Depression Inventory, and the State and Trait Anxiety Inventory	baseline, 4, 8, 12 and 16 weeks
Discontinuation rates due to treatment-related adverse events, proportion of patients experiencing adverse events, proportion of patients experiencing serious adverse events, adverse events description and classification.	baseline, 0, 4, 8, 12 and 16 weeks

Collaborators and Investigators

• Sponsor: Universidad de Granada
• Collaborators: AstraZeneca; Hospital Clinico Universitario San Cecilio
• Investigators: Principal Investigator: Elena P Calandre, MD, Clinical Pharmacology Department of the Hospital Clinico Universitario San Cecilio

Publications and helpful links

General Publications

• Hidalgo J, Rico-Villademoros F, Calandre EP. An open-label study of quetiapine in the treatment of fibromyalgia. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):71-7. doi: 10.1016/j.pnpbp.2006.06.023. Epub 2006 Aug 4.

Study record dates

Study Major Dates

• Study Start: November 1, 2008
• Primary Completion (Actual): March 1, 2010
• Study Completion (Actual): October 1, 2010

Study Registration Dates

• First Submitted: October 1, 2008
• First Submitted That Met QC Criteria: October 2, 2008
• First Posted (Estimate): October 3, 2008

Study Record Updates

• Last Update Posted (Estimate): December 3, 2014
• Last Update Submitted That Met QC Criteria: December 1, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: fibromyalgia; quetiapine; amitriptyline
• Additional Relevant MeSH Terms: Nervous System Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Muscular Diseases; Neuromuscular Diseases; Fibromyalgia; Myofascial Pain Syndromes; Physiological Effects of Drugs; Adrenergic Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Analgesics, Non-Narcotic; Antipsychotic Agents; Tranquilizing Agents; Psychotropic Drugs; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Antidepressive Agents; Antidepressive Agents, Tricyclic; Adrenergic Uptake Inhibitors; Quetiapine Fumarate; Amitriptyline
• Other Study ID Numbers: D1443C00024