背景:多发性硬化(MS)是一种慢性免疫介导的炎性疾病。疲劳是MS患者最常见的症状,影响>80%的受试者。药物治疗是管理疲劳的重要方法。目前,尽管许多药物已被测试用于治疗MS疲劳,这些药物的疗效尚不清楚.
方法:我们研究了PubMed,Embase,Medline,谷歌学者,Cochrane图书馆(2016年8月31日)。搜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,乙酰肉碱,匹莫林,4-氨基吡啶和随机对照试验(RCT)。要求两名研究人员独立评估文献质量,并完成数据提取。采用RevMan5.3软件进行Meta分析。
结果:共纳入11项RCTs,涉及723例患者。通过不同的尺度量化治疗效果,例如修正的疲劳冲击量表(MFIS)或疲劳严重程度量表(FSS)。这里,荟萃分析表明金刚烷胺,不是莫达非尼,对MS的疲劳治疗有效。此外,两项研究提示左卡尼汀可能与金刚烷胺具有相似的治疗效果.然而,有限的样本量大大削弱了这一发现的可靠性。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以外的所有药物对于治疗MS疲劳都是相对安全的。
结论:目前有限的数据表明,金刚烷胺可能是治疗MS疲劳症状的唯一具有相对充分证据的药物。需要招募更大样本量的进一步RCT研究来验证这些候选药物的治疗效果。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.