“No association between disease modifying treatment and fatigue in multiple sclerosis” 2023 Broch et al

Highlights

• The cause of MS-related fatigue is elusive, but inflammation is a proposed mechanism.
• Few studies have compared effect of disease modifying treatments on fatigue.
• MS-related fatigue affected 80% of the pwMS in this large cross-sectional study.
• We found no association between treatment with moderate-efficacy or high-efficacy disease modifying drugs and fatigue.
• There was no association between disease activity measured by clinical relapse and new MRI changes and fatigue.

Abstract

Background
Fatigue affects 60–90% of people with multiple sclerosis (MS). It reduces quality of life and the ability to work. The cause of fatigue in MS remains unknown. Several disease-modifying treatments (DMTs) slow the disease process in relapsing MS by suppressing neuroinflammation. We aimed to investigate if treatment with a DMT is associated with lower rates of fatigue.

Methods
In this cross-sectional study of the MS population in three counties in Norway, we used the Fatigue Scale for Motor and Cognitive Functions (FSMC) and the Hospital Anxiety and Depression Scale (HADS) to assess patient-reported fatigue, anxiety and depression. Clinical data were retrieved from the electronic patient record system. We categorized DMTs as high-efficacy therapy or moderate-efficacy therapy. High-efficacy drugs included fingolimod, natalizumab, ocrelizumab, rituximab, alemtuzumab, daclizumab, and autologous hematopoietic stem cell transplantation. Moderate-efficacy drugs included interferons, glatiramer acetate, dimethyl fumarate, and teriflunomide. We included persons with relapsing MS only.

Results
Of 1142 patients, 80% had fatigue. Fifty-six percent of the patients were on DMTs (25% on moderate-efficacy treatment and 30% on high-efficacy treatment), 18% had discontinued treatment and 26% had never received any DMT. Sex, level of disability as measured by the Multiple Sclerosis Severity Score, anxiety and depression were independently associated with fatigue. Moderate-efficacy treatment was associated with less fatigue, but not after adjustment for other variables. There was no association between high-efficacy treatment and fatigue.

Conclusion
We found no independent relationship between the use of disease-modifying treatment and fatigue in MS.

Open access, https://www.msard-journal.com/article/S2211-0348(23)00494-7/fulltext