Long-term effect of cognitive behavioural therapy and doxycycline treatment for Q fever fatigue syndrome: Qure follow-up (2018) Raijmakers et al

Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study (2018)
Ruud P.H. Raijmakers, Stephan P. Keijmel, Evi M.C. Breukers, Gijs Bleijenberg, Jos W.M. van der Meer, Chantal P. Bleeker-Rovers, Hans Knoop

Abstract

BACKGROUND:
Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial.

METHODS:
All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity.

RESULTS:
Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2-42.9] and 31.3 [95% CI, 27.5-35.1], mean difference 8.2 [95% CI, 4.9-11.6]; P < .001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1-43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5-44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6-40.7]; P = .92 and P = .38, respectively).

CONCLUSION:
The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions

(Underline and bolding mine)

Link to article here (paywall)

Note: I decided to post in this category because Q-Fever is one of the ME/cfs trigger.

Edit to add: Apologies, this is not a new paper, it dates from Nov 2018

 

Reading between the lines, "So CBT doesn't work but it's still worth doing...because it keeps us in a job.". Talk about false illness beliefs, or would it be false treatment beliefs?

@dave30th , one worth you looking at, I think.

 

There has never been any research that indicates long term antibiotic use reduces fatigue. So one useless treatment has side effects so another useless treatment is the best option

 

It's funny how they didn't consider the alternative hypothesis, that CBT causes a temporary change (bias) in questionnaire answering behaviour that doesn't reflect underlying health. At longer term followups, this bias disappears.

 

The Qure study is discussed in this blog, Trial By Error: CBT Model of Medically Unexplained Symptoms, Explained; CBT Trial for Q-Fever Fatigue