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Background: Multiple sclerosis MS is an important problem both for people with the disease and for society. There is no cure, and alleviation of symptoms forms the cornerstone of care. Excessive fatigue that severely limits activity is experienced by at least two-thirds of the estimated 60, people with MS in the UK. Objectives: 1 To identify current treatments for fatigue in MS and their evidence-base. Methods: The review was carried out in two stages: a formal scoping review to assess the range of interventions used by people with MS , and a systematic review for treatments that had been identified as promising and that had been investigated in clinical trials as identified in the scoping review. A systematic review of research on costs and cost-effectiveness of those interventions identified as promising was also performed. Reference lists from publications were also searched, and experts were contacted for any additional information not already identified. Results: Interventions identified for the treatment of fatigue in MS 1 Behavioural advice. This is the main element of initial clinical management and no rigorous research of its effectiveness was identified. Only two drugs, amantadine and pemoline, met the criteria for full systematic review. All studies were open to bias. All studies showed a pattern in favour of amantadine compared with placebo, but there is considerable uncertainty about the validity and clinical significance of this finding. This pattern of benefit was considerably undermined when different assumptions were used in the sensitivity analysis. Both studies were open to bias. There was no overall tendency in favour of pemoline over placebo and an excess of reports of adverse effects with pemoline. No economic evaluations were identified in the systematic review, and available data were insufficient to allow modelling of cost-effectiveness in this rapid review. Conclusions: There is insufficient evidence to allow people with MS, clinicians or policy makers to make informed decisions on the appropriate use of the many treatments on offer. Only amantadine appears to have some proven ability to alleviate the fatigue in MS, though only a proportion of users will obtain benefit and then only some of these patients will benefit sufficiently to take the drug in the long term. People with MS, clinicians and policy makers should work together to ensure that the evidence required is collected as quickly as possible by encouraging involvement in rigorous research. Research should not be restricted to the two drugs reviewed in depth in this report. All interventions identified in the scoping review see above should be considered, as should basic scientific research into the underlying mechanism of fatigue in MS. Abstract Background: Multiple sclerosis MS is an important problem both for people with the disease and for society. Publication types Research Support, Non-U. Gov't Review Systematic Review.
Background: Multiple sclerosis (MS) is an important problem both for people with the disease and for society. There is no cure, and alleviation of symptoms.
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