In a research study focused on frequently utilized therapies for multiple sclerosis (MS), both medical treatments and behavioral approaches, as well as a combination of these methods, showed notable enhancements in reducing fatigue. The researchers believe these results could influence how clinicians tackle one of the most difficult symptoms faced by individuals with MS.
A study led by the University of Michigan examined commonly implemented treatments for multiple sclerosis and found that both medical therapies and behavioral strategies, including their combination, led to significant reductions in fatigue.
This randomized clinical trial assessed the effectiveness of modafinil, a medication that promotes wakefulness and is typically used for sleep disorders, and cognitive behavioral therapy (CBT) in alleviating fatigue among over 300 adults with MS whose symptoms impacted their daily life.
Overall, the researchers discovered that both modafinil and CBT, which was provided through telephone sessions, resulted in significant decreases in fatigue over a 12-week period.
The combo of both treatments also yielded improvements similar to each treatment on its own but did not produce better results compared to the individual methods.
The results have been published in The Lancet Neurology.
“Fatigue is one of the most prevalent and disabling issues in multiple sclerosis. However, there remains confusion regarding the application of existing treatments and how medication-based options compare to behavioral approaches in real-world settings,” stated Tiffany J. Braley, M.D., M.S., the first author and director of the Multiple Sclerosis/Neuroimmunology Division at the University of Michigan Health.
“This study provides fresh evidence demonstrating that both CBT and modafinil are comparably effective in treating MS-related fatigue, which could potentially revolutionize treatment strategies for this challenging symptom among people with MS.”
Among the nearly 3 million individuals with multiple sclerosis globally, up to 90% report experiencing fatigue, with nearly half indicating it as their most debilitating and impactful symptom.
This research adopted a real-world framework, closely resembling clinical practice rather than traditional clinical trials, and involved MS stakeholders in the study’s design.
More than 60% of participants in each treatment group reported meaningful decreases in fatigue, which was evaluated using the Modified Fatigue Impact Scale.
“These therapies, individually and in combination, should be considered viable options for managing chronic fatigue in people with multiple sclerosis,” said Anna L. Kratz, Ph.D., the senior author and a professor at the U-M Medical School.
Both Braley and Kratz led the study, which received funding from the Patient-Centered Outcomes Research Institute.
Researchers from the University of Washington, a secondary site for the study, contributed to this practical trial.
“This study placed a strong emphasis on outcomes that matter to patients, underscoring the significance of collaborative treatment decision-making that takes into account individual patient characteristics and wider treatment objectives,” Braley added.
Participants who received only CBT continued to show lower fatigue levels during a follow-up appointment 12 weeks after the study concluded.
Previous research has indicated that CBT yields strong and lasting effects on fatigue.
“Many individuals with multiple sclerosis lack adequate access to behavioral health services like CBT; however, providing these treatments through telehealth can expand access to more patients,” Kratz stated.
“Our findings indicate that CBT is a practical option that equips patients with fatigue management techniques that they can use indefinitely, with lasting benefits extending beyond the treatment term.”
Even though the three treatment methods were similarly effective overall, participants’ sleep patterns, or “sleep hygiene,” appeared to influence their treatment outcomes regarding fatigue.
Those with subpar sleep hygiene tended to achieve better fatigue results from CBT, while those with excellent sleep hygiene fared better with modafinil.
“Using wake-promoting drugs like modafinil might impair sleep quality for patients whose sleep issues stem from behavioral problems,” Braley remarked.
“Given that sleep disturbances also contribute to fatigue among individuals with MS, it is essential to avoid choosing fatigue treatments that could negatively impact sleep. Behavioral therapies like CBT that provide sleep education may be more suitable for MS patients with poor sleep hygiene.”
