Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second People's Hospital of Banan District, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China.
Department of Hematology and Oncology, Chongqing Cancer Institute & Hospital & Cancer Center, Chongqing, China.
J Neurol Sci. 2017 Sep 15;380:256-261. doi: 10.1016/j.jns.2017.07.042. Epub 2017 Jul 28.
Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease. Fatigue is the most common symptom of MS patients, affecting >80% subjects. Medical treatment is an important method for managing fatigue. Currently, although many drugs have been tested in treatment of MS fatigue, the efficacy of these drugs remain largely unclear.
We researched available literatures in PubMed, Embase, Medline, Google Scholar, Cochrane Library (August 31, 2016). Search terms included multiple sclerosis, fatigue, medication treatments, amantadine, modafinil, aspirin, acetyl-l-carnitine, pemoline, 4-aminopyridine and randomized controlled trial (RCT). Two researchers were required to independently assess the quality of literatures, and finish data extraction. Meta-analysis was conducted using RevMan 5.3 software.
A total of 11 RCTs involving 723 patients were included. The therapeutic effects were quantified by different scales, such as Modified Fatigue Impact Scale (MFIS) or Fatigue Severity Scale (FSS). Here, meta-analysis suggested that amantadine, not modafinil, was effective for treating the fatigue in MS. Moreover, two studies implied that l-carnitine might have similar therapeutic effect with amantadine. However, the reliability of this finding was greatly weakened by the limited sample sizes. Additionally, current data could not answer whether treatment of MS fatigue using aspirin or 4-aminopyridine was beneficial. Finally, we found that all drugs except pemoline were relatively safe for treating MS fatigue.
Current limited data suggest that amantadine may be the only drug that has relatively sufficient evidences in treatment of fatigue symptoms in MS. Further RCT studies recruiting larger samples sizes are required to validate the therapeutic effect of these candidate drugs.
多发性硬化症（MS）是一种慢性免疫介导的炎症性疾病。疲劳是 MS 患者最常见的症状，影响超过 80%的患者。医学治疗是管理疲劳的重要方法。目前，尽管已经有许多药物在治疗 MS 疲劳方面进行了测试，但这些药物的疗效在很大程度上仍不清楚。
我们在 PubMed、Embase、Medline、Google Scholar、Cochrane Library（2016 年 8 月 31 日）中检索了可用的文献。检索词包括多发性硬化症、疲劳、药物治疗、金刚烷胺、莫达非尼、阿司匹林、乙酰左旋肉碱、匹莫林、4-氨基吡啶和随机对照试验（RCT）。两名研究人员需要独立评估文献质量，并完成数据提取。使用 RevMan 5.3 软件进行荟萃分析。
共纳入 11 项 RCT，涉及 723 例患者。使用不同的量表（如改良疲劳影响量表（MFIS）或疲劳严重程度量表（FSS））来量化治疗效果。荟萃分析表明，金刚烷胺而非莫达非尼对治疗 MS 疲劳有效。此外，两项研究表明左旋肉碱可能与金刚烷胺具有相似的治疗效果。然而，由于样本量有限，这一发现的可靠性大大降低。此外，目前的数据无法回答使用阿司匹林或 4-氨基吡啶治疗 MS 疲劳是否有益。最后，我们发现除了匹莫林之外，所有药物治疗 MS 疲劳的安全性相对较高。
目前有限的数据表明，金刚烷胺可能是唯一一种在治疗 MS 疲劳症状方面具有相对充分证据的药物。需要进一步进行招募更大样本量的 RCT 研究来验证这些候选药物的治疗效果。
