Letter to the Editor
Agomelatine Adjunctive Therapy for Fibromyalgia
Uso de agomelatina como tratamiento coadyuvante en la fibromialgia
Oscar Medina Ortiz
, Gerardo Rico, Luis Oliveros, Nora Sánchez-Mora
Corresponding author
Cátedra de Psiquiatría, Psicología de la Salud y Medicina del Sueño, Facultad de Medicina, Universidad de los Andes, San Cristóbal, Venezuela
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=> array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Gerardo" "apellidos" => "Rico" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Oliveros" ] 3 => array:2 [ "nombre" => "Nora" "apellidos" => "Sánchez-Mora" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cátedra de Psiquiatría, Psicología de la Salud y Medicina del Sueño, Facultad de Medicina, Universidad de los Andes, San Cristóbal, Venezuela" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de agomelatina como tratamiento coadyuvante en la fibromialgia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1009 "Ancho" => 1535 "Tamanyo" => 105798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the patient after treatment with agomelatine (16 weeks).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Fibromyalgia is a chronic disease that can affect the patient from a biological, psychological and social point of view.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It includes symptoms such as extreme fatigue, persistent pain, stiffness of muscles, tendons and soft tissue, trouble sleeping, memory disturbances, depression and anxiety, among others.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The antidepressant agomelatine is an agonist of MT1 and MT2 melatoninergic receptors<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and antagonist of postsynaptic serotonin receptors (5-HT2C), with the ability to “resynchronize” the biological clock.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on empirical observation of several rheumatologists of San Cristóbal (Venezuela) on the apparent efficacy of agomelatine in fibromyalgia resistant to conventional treatment, we present a case of a 43 year old female patient, diagnosed with fibromyalgia 3 years prior, and treated with <span class="elsevierStyleSmallCaps">l</span>-arginine base, pregabalin, amitriptyline, tryptophan, meloxicam and B vitamin complex. Since no therapy had proven effective pharmacotherapy we indicated agomelatine 25<span class="elsevierStyleHsp" style=""></span>mg at bedtime as adjuvant treatment and an amitriptyline substitute. The case was followed for 16 weeks and assessed with the following instruments: Fibromyalgia Impact Questionnaire (FIQ), LANSS pain scale, Pittsburgh sleep quality index and the widespread pain index.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Initially, the patient was impaired with physical appearance, sleeplessness, muscle aches and fatigue. In week 2 appreciate a clear improvement in the aforementioned parameters. At six weeks the improvement in sleep disturbance was clinically significant and sleep latency was reduced from 15 to 5<span class="elsevierStyleHsp" style=""></span>min and increased nighttime sleep increased from 5 to 8<span class="elsevierStyleHsp" style=""></span>h; the patient was able to perform most of her activities regularly and her mood improved. At week 14, the patient had regained full ability to perform daily activities and had better pain tolerance, which was maintained at week 16. <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the evolution of the clinical symptoms of the patient with the scores of the scales used, FIQ, pain scale and the LANSS Pittsburgh Sleep quality index.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Apparently, adjuvant treatment with agomelatine could improve the physical and psychological condition of some patients with fibromyalgia who have not responded to conventional drugs, especially with regard to sleep and pain perception, and that fibromyalgia may be more severe in patients with increased sleep disturbances, relating this with a greater number of tender points and more intense and enduring pain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The reason agomelatine could improve fibromyalgia patients is not clear; however, this molecule can “resynchronize” sleep patterns and circadian rhythm, and being agonist of melatonin receptors, could impact on the improvement of some symptoms of the disease, considering that patients with fibromyalgia may have up to 31% less melatonin secretion at night,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> with this is contributing to greater sleep disturbances, daytime fatigue and changes in pain perception. So the intervention in circadian rhythms might be an important factor in the treatment of fibromyalgia.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">While studies are inconclusive and some authors do not consider changes in the levels of melatonin and circadian rhythms in patients with fibromyalgia relevant or significant,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and we found only one only study in which the use of agomelatine in these patients either appears to show significant efficacy,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> or is likely to benefit a particular group of patients with fibromyalgia, especially those who have not responded to drugs commonly used to treat this condition.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Further studies with a larger number of patients and an improved method must be more strictly performed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Disclosures</span><p id="par0040" class="elsevierStylePara elsevierViewall">None of the authors manifest any conflict of interest, even if the treatment with agomelatine was provided by Servier Laboratories of Venezuela, during the 16-week follow-up.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Disclosures" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Medina Ortiz O, et al. Uso de agomelatina como tratamiento coadyuvante en la fibromialgia. Reumatol Clin. 2013;9:328–329.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1009 "Ancho" => 1535 "Tamanyo" => 105798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the patient after treatment with agomelatine (16 weeks).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibromyalgia: a biopsychosocial syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. 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Vilchez-Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Basic Clin Pharmacol Toxicol" "fecha" => "2011" "volumen" => "109" "numero" => "Suppl 3" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000900000005/v2_201403300049/S2173574313000579/v2_201403300049/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000900000005/v2_201403300049/S2173574313000579/v2_201403300049/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000579?idApp=UINPBA00004M" ]
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| 2022 August | 97 | 33 | 130 |
| 2022 July | 91 | 43 | 134 |
| 2022 June | 77 | 34 | 111 |
| 2022 May | 91 | 57 | 148 |
| 2022 April | 100 | 40 | 140 |
| 2022 March | 95 | 52 | 147 |
| 2022 February | 103 | 43 | 146 |
| 2022 January | 112 | 47 | 159 |
| 2021 December | 78 | 47 | 125 |
| 2021 November | 84 | 54 | 138 |
| 2021 October | 133 | 49 | 182 |
| 2021 September | 92 | 44 | 136 |
| 2021 August | 65 | 30 | 95 |
| 2021 July | 66 | 20 | 86 |
| 2021 June | 84 | 35 | 119 |
| 2021 May | 88 | 43 | 131 |
| 2021 April | 152 | 91 | 243 |
| 2021 March | 156 | 29 | 185 |
| 2021 February | 113 | 27 | 140 |
| 2021 January | 80 | 23 | 103 |
| 2020 December | 64 | 28 | 92 |
| 2020 November | 116 | 19 | 135 |
| 2020 October | 92 | 15 | 107 |
| 2020 September | 122 | 27 | 149 |
| 2020 August | 95 | 10 | 105 |
| 2020 July | 77 | 20 | 97 |
| 2020 June | 49 | 18 | 67 |
| 2020 May | 66 | 19 | 85 |
| 2020 April | 79 | 22 | 101 |
| 2020 March | 20 | 14 | 34 |
| 2020 February | 2 | 0 | 2 |
| 2019 April | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 59 | 2 | 61 |
| 2018 March | 109 | 7 | 116 |
| 2018 February | 55 | 5 | 60 |
| 2018 January | 420 | 5 | 425 |
| 2017 December | 198 | 5 | 203 |
| 2017 November | 33 | 1 | 34 |
| 2017 October | 50 | 5 | 55 |
| 2017 September | 34 | 7 | 41 |
| 2017 August | 43 | 4 | 47 |
| 2017 July | 41 | 8 | 49 |
| 2017 June | 123 | 14 | 137 |
| 2017 May | 55 | 8 | 63 |
| 2017 April | 27 | 4 | 31 |
| 2017 March | 52 | 24 | 76 |
| 2017 February | 61 | 2 | 63 |
| 2017 January | 43 | 4 | 47 |
| 2016 December | 70 | 17 | 87 |
| 2016 November | 75 | 8 | 83 |
| 2016 October | 114 | 13 | 127 |
| 2016 September | 146 | 6 | 152 |
| 2016 August | 64 | 4 | 68 |
| 2016 July | 34 | 2 | 36 |
Show all
