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
