What treats Multiple Sclerosis (MS) fatigue?

From the Guidelines

Multiple Sclerosis (MS) fatigue can be treated with a multifaceted approach, including tailored physical activity interventions, structured and tailored psychoeducational interventions, and immunomodulatory treatment initiation or change, if clinically indicated.

Treatment Options

• Tailored physical activity interventions: Supervised physical activity interventions can help reduce fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs), and long-term physical activity as a lifestyle change should be encouraged 1.
• Structured and tailored psychoeducational interventions: Psychoeducational interventions can help reduce fatigue in people with I-RMDs, and access to these interventions should be discussed periodically and be needs-based 1.
• Immunomodulatory treatment initiation or change: Pharmacological interventions that reduce disease activity, such as biologic agents, can also reduce fatigue in people with I-RMDs, especially if high levels of inflammatory disease activity are present 1.

Key Considerations

• Regular assessment of fatigue: Health professionals should incorporate regular assessment of fatigue severity, impact, and coping strategies into clinical consultations, and not make assumptions about when someone might be impacted by fatigue 1.
• Shared decision-making: The role of health professionals is to engage in shared decision-making with the person with an I-RMD and fatigue, and to facilitate access to management options 1.
• Patient-centred fatigue management: Fatigue management should consider the individual’s needs and preferences, their clinical disease activity, comorbidities, and other psychosocial and contextual factors 1.

From the Research

Treatments for Multiple Sclerosis (MS) Fatigue

• Pharmacological treatments:
  • Amantadine is currently recommended for treating MS-related fatigue 2, 3
  • Modafinil has been studied, but its effectiveness is unclear and results are contrasting 4, 5, 3
  • Methylphenidate is being studied in a clinical trial 5
  • Acetyl-l-carnitine may have a therapeutic effect, but more research is needed 3
• Non-pharmacological treatments:
  • Physical, psychological, and mixed physical/psychological interventions are supported by several studies 6, 2
  • A multidisciplinary team approach is recommended for assessing and managing MS-related fatigue 2

Ongoing Research

• A clinical trial (TRIUMPHANT-MS) is being conducted to compare the efficacy of amantadine, modafinil, and methylphenidate in treating MS-related fatigue 5

Key Findings

• Amantadine is the only drug with relatively sufficient evidence for treating fatigue symptoms in MS 3
• More research is needed to validate the therapeutic effect of other candidate drugs 3