Multiple sclerosis trials suggest that medication and cognitive behavioral therapy can reduce fatigue

In a study of commonly used treatments for people with multiple sclerosis, medical and behavioral interventions, and a combination of both, resulted in meaningful improvement in fatigue, a study by the University of Michigan found.

A randomized clinical trial compared the effectiveness of modafinil, a wakefulness-promoting drug used to treat insomnia in people with insomnia, and cognitive behavioral therapy, or CBT, to reduce fatigue in people with insomnia. 300 people with multiple sclerosis whose symptoms interfered with their daily activities. .

Overall, the researchers found that treatment with modafinil or CBT alone, delivered over the phone, was associated with a significant reduction in fatigue over 12 weeks.

The combination of both treatments also worked as well as the individual treatments but did not result in better fatigue scores than the individual interventions.

The findings were published in Lancet Neurology.

First author Tiffany J. Braley said: “Fatigue is one of the most common and debilitating symptoms of multiple sclerosis, yet there is still uncertainty about whether existing treatments are effective. how or whether medication-based treatments are used compared to behavioral treatments in the real world, said first author Tiffany J. Braley. , MD, MS, director of the Multiple Sclerosis/Neuroimmunology Division and co-founder of the Multidisciplinary MS Fatigue and Sleep Clinic at University of Michigan Health.

“This study provides new evidence to show that both CBT and modafinil work in the same way for MS fatigue, which may shape the treatment of one of the most difficult symptoms experienced by people with multiple sclerosis.”

Of the approximately 3 million people with multiple sclerosis worldwide, up to 90% experience fatigue. Almost half describe it as the most disturbing and influential symptom.

The research used a real-world approach that more closely resembles clinical practice than traditional clinical trials and included participants with MS who helped design the study.

More than 60% of participants in each study group reported a meaningful improvement in fatigue, which was measured by a study called the Modified Fatigue Impact Scale.

“These treatments, individually and in combination, should be considered as a possible option for people with multiple sclerosis who have chronic, problematic fatigue,” the said senior author Anna L. Kratz, Ph.D., UM professor of physical medicine and rehabilitation. School of Medicine.

Braley and Kratz led the study. Colleagues from a second academic institution, the University of Washington, participated in this pragmatic experiment.

“This study is very focused on patient outcomes, and our findings highlight the importance of shared decision-making regarding treatment options, taking into account patient characteristics and broad treatment goals,” Braley said.

Trial participants who received CBT alone maintained lower fatigue scores during an additional follow-up session 12 weeks after the study treatment ended.

CBT has shown strong and lasting effects on fatigue in previous studies.

“Although many people with multiple sclerosis have limited access to behavioral health care such as CBT, providing treatment via telehealth can help reach more patients,” Kratz said.

“Our research shows that CBT is a feasible treatment that teaches the ability to manage fatigue that can be used indefinitely, with lasting benefits that last beyond the duration of treatment.”

Although the three treatment groups worked equally well overall, the participants’ sleep patterns, or “sleep hygiene,” affected how well the treatment worked for fatigue.

Those with poor sleep hygiene tended to have better fatigue outcomes with CBT, and participants with good sleep hygiene showed better fatigue outcomes with modafinil.

“Using wakefulness-promoting medications such as modafinil can worsen sleep quality in patients whose sleep problems are behavioral in nature,” Braley said.

“As sleep disturbances also contribute to fatigue in people with MS, it is important to avoid choosing fatigue treatments that may worsen sleep. Behavioral therapies such as CBT that include sleep education can be good for people with MS who have bad sleeping habits.”