Mohsen Rastkar, Saba Ghandchi, Mahyar Ghajarzadeh, Mahsa Ghajarzadeh
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引用次数: 0
Abstract
Background: Fatigue is a disabling symptom of multiple sclerosis (MS) with an unknown etiology. Various medications are used to treat MS-related fatigue, but none of the available studies directly compared the head-to-head efficacy of all these medications. So, we designed this meta-analysis to compare the efficacy of these drugs in treating MS-related fatigue.
Methods: PubMed, Scopus, EMBASE, PsycINFO, and Web of Science were thoroughly searched by two independent researchers on 1 March 2025. Mean difference (SMD) was used as the effect size, and surface under the cumulative ranking curve (SUCRA) was applied to rank interventions.
Results: 15 studies were ultimately included in the systematic review. For fatigue severity, none of the medications were superior to placebo. For fatigue impact (MFIS) compared with placebo, Amantadine (MD -12.11, 95% CI -14.28 to -9.94), Dalfampridine (MD -14.05, 95% CI -22.59 to -5.52, and Methylphenidate (MD -5.25, 95% CI -8.44 to -2.06) were associated with statistically significant improvements. In contrast, CBT (MD 1.40, 95% CI -1.99 to 4.80), and Modafinil (MD 0.60, 95% CI -1.26 to 2.46) did not differ significantly from placebo.
Conclusions: Amantadine, dalfampridine, and methylphenidate were found to be superior to placebo in improving the impact of fatigue on patients' lives.
背景：疲劳是多发性硬化症（MS）的致残症状，病因不明。各种各样的药物被用来治疗多发性硬化症相关的疲劳，但没有一个可用的研究直接比较所有这些药物的疗效。因此，我们设计了这个荟萃分析来比较这些药物在治疗多发性硬化症相关疲劳方面的疗效。方法：两位独立研究者于2025年3月1日对PubMed、Scopus、EMBASE、PsycINFO和Web of Science进行全面检索。效应量采用平均差（Mean difference， SMD），排序采用累积排序曲线下曲面（surface under the cumulative ranking curve， SUCRA）。结果：15项研究最终被纳入系统评价。就疲劳严重程度而言，没有一种药物优于安慰剂。对于疲劳影响（MFIS），与安慰剂相比，Amantadine (MD -12.11, 95% CI -14.28至-9.94),Dalfampridine （MD -14.05, 95% CI -22.59至-5.52）和Methylphenidate （MD -5.25, 95% CI -8.44至-2.06）与统计学上显著改善相关。相比之下，CBT （MD 1.40, 95% CI -1.99 - 4.80）和莫达非尼（MD 0.60, 95% CI -1.26 - 2.46）与安慰剂没有显著差异。结论：金刚烷胺、dalfampridine和哌醋甲酯在改善疲劳对患者生活的影响方面优于安慰剂。
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