Dr. Andrew Holman

Andrew J. Holman MD, is Assistant Clinical Professor of Medicine at the University of Washington and practices rheumatology at Valley Medical Center in a Seattle suburb. He completed his undergraduate studies at Bowdoin College in 1981 and received his medical degree from the University of Missouri-Columbia in 1987. His internal medicine residency training was completed at Denver Presbyterian Medical Center in 1990. After his rheumatology fellowship at the University of Washington, he has practiced clinical rheumatology while exploring new options for fibromyalgia and autoimmune connective tissue diseases. His research focuses on autonomic dysregulation, hypermobility syndrome and how the autonomic nervous system interacts with the immune system.

His hypothesis that autonomic arousal from deep, restorative sleep underlies the pathogenesis of fibromyalgia led to American College of Rheumatology poster presentations in 1998-2000 describing the use of Restless Legs Syndrome options for fibromyalgia. Ultimately, this work led to use of dopamine agonists for fibromyalgia, a technique approved by US patent in 2001. Further examination of second-generation, dopamine-3 receptor specific agonists, including pramipexole and ropinirole, are ongoing.

In August 2005, Dr. Holman’s study on the use of Pramipexole, a dopamine agonist, in the treatment of fibromyalgia was published in Arthritis and Rheumatism. His research illustrated that a subset of patients with fibromyalgia, responded favorably to pramipexole, including improved scores on assessments of pain, fatigue, function, and global status. It was also shown to be safe and well-tolerated by the research subjects. Please refer to the below abstract for more information on this study.

Contact information:

Andrew J. Holman, MD
4011 Talbot Rd. South
Renton, WA 98055
Email: AJHSeattle@ aol.com

A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Andrew J. Holman and Robin R. Myers.

OBJECTIVE: To assess the efficacy and safety of pramipexole, a dopamine 3 receptor agonist, in patients with fibromyalgia. METHODS: In this 14-week, single-center, double-blind, placebo-controlled, parallel-group, escalating-dose trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo) to receive 4.5 mg of pramipexole or placebo orally every evening. The primary outcome was improvement in the pain score (10-cm visual analog scale [VAS}) at 14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain improvement scale, the tender point score, the 17-question Hamilton Depression Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities and disability were not excluded. Stable dosages of concomitant medications, including analgesics, were allowed. RESULTS: Compared with the placebo group, patients receiving pramipexole experienced gradual and more significant improvement in measures of pain, fatigue, function, and global status. At 14 weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the placebo arm (treatment difference –1.77 cm). Forty-two percent of patients receiving pramipexole and 14% of those receiving placebo achieved >50% decrease in pain. Secondary outcomes favoring pramipexole over placebo included the total FIQ score (treatment difference –9.57) and the percentages of improvement in function (22% versus 0%), fatigue (29% versus 7%), and global (38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes showed a better trend for pramipexole treatment than for placebo, but failed to reach statistical significance, including improvement in the tender point score (51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%), and BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end points showed a better trend for the placebo arm. The most common adverse events associated with pramipexole were transient anxiety and weight loss. No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole. CONCLUSION: In a subset of patients with fibromyalgia, ~50% of whom required narcotic analgesia and/or were disabled, treatment with pramipexole improved scores on assessments of pain, fatigue, function, and global status, and was safe and well-tolerated. nfra.net/OtherAbs.htm

Arth and Rheum, vol. 52, No. 8, Aug 2005, pp 2495-2505

Obesity Link to Fibromyalgia
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