#269 Osteoarthritis pain getting you down? Duloxetine

Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
- Proportion of patients attaining a meaningful pain reduction (generally ≥30% reduction in pain score):
- Systematic review (6 RCTs, 2060 patients)1 of hip or knee osteoarthritis, over 10-18 weeks: 64% taking duloxetine versus 43% taking placebo, number needed to treat (NNT)=5.
- Other systematic reviews found similar:3,5-6 NNT=6-9.
- One RCT (231 patients) randomized patients to 60mg or 120mg and found no difference.7
- Improvement in baseline pain scores (0-10 point scale, lower scores indicate less pain):
- Systematic review (5 RCTs, 2059 patients),5 patients started with an average score of 5.8: duloxetine improved pain 0.8 more than placebo, achieving a mean pain score of 3.3 versus 4.1 for placebo which is likely clinically meaningful.
- Another systematic review found similar.3
- Adverse events:
- Overall adverse events:4 55% versus 37% (placebo), number needed to harm (NNH)=6.
- Most common adverse events:4 gastrointestinal 36% versus 8% (placebo), (NNH=4).
- Specifically6 nausea (NNH 16), fatigue (NNH 17), constipation (NNH 19), erectile dysfunction (NNH 20), abdominal pain (NNH 34).
- Most common adverse events:4 gastrointestinal 36% versus 8% (placebo), (NNH=4).
- Withdrawal due to adverse events:4 12% versus 6% (placebo), NNH=17.
- Other systematic reviews found similar.1-6
- Limitations: all industry-funded studies.
- Overall adverse events:4 55% versus 37% (placebo), number needed to harm (NNH)=6.
- No RCTs looked at venlafaxine to treat osteoarthritis pain.
- Duloxetine is “conditionally recommended” by the Osteoarthritis Research Society International guidelines and by the American College of Rheumatology, however, tolerability needs to be considered.8-9
- A PEER Simplified Decision Aid on osteoarthritis can assist with patient informed decision making and is available online.10