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Amantadine for fatigue in multiple sclerosis

  • Review
  • Intervention

Authors


Abstract

Background

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.

Objectives

To determine the effectiveness and safety of amantadine in treating fatigue in people with MS.

Search methods

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.

Selection criteria

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.

Main results

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%.

Authors' conclusions

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.

摘要

背景

Amantadine用於治療多發性硬化導致的疲勞

疲勞是多發性硬化患者最常見的症狀,足以使人失能。有效地處理疲勞感可改善病人的生活機能、工作能力、和生活品質。雖然目前有不少減少疲勞的治療策略,但這些治療建議的科學根據都很有限。許多教科書提到amantadine是治療此類疲勞的首選,因為隨機對照試驗發表文獻中有發現一些療效。

目標

檢視amantadine用於治療多發性硬化引發的疲勞,其效力及安全性。

搜尋策略

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。

選擇標準

治療有疲勞問題的多發性硬化病人,使用安慰劑或其他藥物作為對照組與amantadine比較的隨機雙盲試驗。

資料收集與分析

三個檢閱者分別選取可以納入本回顧的研究,並從原文擷取所需的資料。我們也額外向這些研究的試驗主持人索取文章中不足或不清楚的資料。因為資料的不完整和過度的異質性,使得我們無法對治療結果進行統合分析。

主要結論

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%.

作者結論

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

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

需要更多研究探討Amantadine對多發性硬化病患疲勞的療效。硬化是影響青年和中年成人的慢性疾病。最常見和影響生活機能的的症狀為疲勞。雖然有不同方式用於減少疲勞,包含維持精力,特殊體能訓練和藥物。amantadine被用於治療多發性硬化病患的疲勞。本回顧發現很少文獻紀錄amantadine 對減少多發性硬化病患疲勞的療效和耐受性。

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.

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