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Which treatments improve fatigue and quality of life in MS? Researchers investigate

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  • Which treatments improve fatigue and quality of life in MS? Researchers investigate

    Journal Neurology
    April 09, 2019; 92 (15 Supplement)

    Which treatments improve fatigue and quality of life in Multiple Sclerosis? Evidence appraisal and development of visual interactive evidence maps (P5.2-088)
    Amy Tsou, Jonathan Treadwell, Eileen Erinoff, Karen Schoelles
    First published April 9, 2019,


    Objective: To determine efficacy of MS fatigue interventions and create Web-based, interactive evidence maps for the Patient Centered Outcomes Research Institute (PCORI) describing existing research, efficacy, and ongoing trials.

    Background: Fatigue affects 50 to 80% of patients with multiple sclerosis (MS), with many reporting fatigue as the most troubling symptom. Despite a range of interventions, little is known regarding efficacy for fatigue (including comparative efficacy across modalities) and quality of life (QOL).

    Design/Methods: We performed a systematic review and meta-analysis of MS fatigue treatments. A comprehensive literature search identified potential articles published from 1987 forward. and PCORI’s website were searched to identify ongoing research. For randomized controlled trials (RCTs), we performed meta-analysis of efficacy for fatigue and QOL; adverse effect information was also extracted. Strength of evidence (SOE) was appraised using modified criteria from the AHRQ evidence-based practice system. We created 3 evidence maps using HTML, SVG and JavaScript.

    Results: 282 studies met inclusion criteria. All studies (categorized by design and intervention type) were summarized in Map 1. Map 2 summarizes evidence from 45 RCTs comparing treatments to inactive control. Four interventions (aquatic exercise, combination exercise, supervised aerobic exercise, fatigue self-management) improved both fatigue and QOL. Aquatic exercise reduced fatigue the most (Hedges g=1.66, moderate SOE). Only 1 pharmacologic intervention (paroxetine) improved fatigue, but had insufficient evidence regarding QOL. Map 3 summarizes evidence from 15 RCTs comparing 2 or more active treatments. Sertraline, cognitive behavioral therapy and balance training demonstrated efficacy for fatigue (low to moderate SOE).

    Conclusions: Absence of sufficient evidence for amantadine, modafinil, and methylphenidate was striking given common clinical use and potential for adverse effects. Our findings suggest increased focus on exercise and behavioral/educational interventions is warranted.

    Dave Bexfield