Amantadine for fatigue in multiple sclerosis
Editorial Group: Cochrane Multiple Sclerosis Group
Published Online: 24 JAN 2007
Assessed as up-to-date: 14 NOV 2006
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Pucci E, Brañas Tato P, D'Amico R, Giuliani G, Solari A, Taus C. Amantadine for fatigue in multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD002818. DOI: 10.1002/14651858.CD002818.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 24 JAN 2007
Fatigue is one of the most common and disabling symptoms of people with Multiple Sclerosis (MS). The effective management of fatigue has an important impact on the patient's functioning, abilities, and quality of life. Although a number of strategies have been devised for reducing fatigue, treatment recommendations are based on a limited amount of scientific evidence. Many textbooks report amantadine as a first-choice drug for MS-related fatigue because of published randomised controlled trials (RCTs) showing some benefit.
To determine the effectiveness and safety of amantadine in treating fatigue in people with MS.
We searched The Cochrane MS Group Trials Register (July 2006), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), MEDLINE (January 1966 to July 2006), EMBASE (January 1974 to July 2006), bibliographies of relevant articles and handsearched relevant journals. We also contacted drug companies and researchers in the field.
Randomised, placebo or other drugs-controlled, double-blind trials of amantadine in MS people with fatigue.
Data collection and analysis
Three reviewers selected studies for inclusion in the review and they extracted the data reported in the original articles. We requested missing and unclear data by correspondence with the trial's principal investigator. A meta-analysis was not performed due to the inadequacy of available data and heterogeneity of outcome measures.
Out of 13 pertinent publications, 5 trials met the criteria for inclusion in this review: one study was a parallel arms study, and 4 were crossover trials. The number of randomised participants ranged between 10 and 115, and a total of 272 MS patients were studied. Overall the quality of the studies considered was poor and all trials were open to bias. All studies reported small and inconsistent improvements in fatigue, whereas the clinical relevance of these findings and the impact on patient's functioning and health related quality of life remained undetermined. The number of participants reporting side effects during amantadine therapy ranged from 10% to 57%.
The efficacy of amantadine in reducing fatigue in people with MS is poorly documented, as well as its tolerability. It is advisable to: (1) improve knowledge on the underlying mechanisms of MS-related fatigue; (2) achieve an
agreement on accurate, reliable and responsive outcome measures of fatigue; (3) perform good quality RCTs.
Plain language summary
The effect of amantadine for the treatment of fatigue in people with multiple sclerosis
Multiple sclerosis (MS) is a chronic disease affecting young and middle-aged adults. One of the most common and disabling symptoms of MS is fatigue. Different approaches have been used to try and improve this, including energy conservation, specialised fitness training and drug treatments. Amantadine has been used to try to relieve fatigue in MS. This review found that Amantadine efficacy in reducing MS-related fatigue and its tolerability are poorly documented and more research is needed.
搜尋了以下的資料庫：The Cochrane MS Group Trials Register(2006年7月)、The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2006)、MEDLINE (1966年1月至2006年7月)、EMBASE (1974年1月至2006年7月)，找尋相關的文獻和翻閱相關的期刊。我們也連絡了藥商及此領域的研究人員。
共有13 個適合的文獻(來自5 個試驗資料)符合納入條件。1個試驗為平行設計，其他四個有交換治療。各組隨機分配的人數為10 到115人，共納入272位多發性硬化病患。整體品質不佳，都有可能有偏差。所有試驗結果都顯示只有些微不一致的改進疲勞效果，但此結果與治療的臨床相關性不明，對病患官能和相關的生活品質的影響也不明。治療期間發生副作用的人數比例為10%－57%.
很少文獻紀錄amantadine 對減少多發性硬化病患疲勞的療效和耐受性。建議應：(1) 改進對與多發性硬化相關的疲勞之潛在機制的了解; (2) 建議對疲勞取得共同的準確、可靠和回應性的結果變項; (3) 進行高品質隨機臨床試驗
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。