Source: Clinical Therapeutics Preprint Date: March 11, 2019 URL: https://www.sciencedirect.com/science/article/abs/pii/S0149291819300712 Ref: See March 9 for Part 1 Pharmaceutical interventions in Chronic Fatigue Syndrome: A literature-based commentary --------------------------------------------------------- Spencer Richman(1,2), Matthew C. Morris(1,2), Gordon Broderick (1,2,3,5,*), Travis J.A. Craddock(3,4,6), Nancy G. Klimas(3,6), Mary Ann Fletcher(3,6) 1 Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, NY, USA 2 Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA 3 Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA 4 Departments of Psychology and Neuroscience, Computer Science, Nova Southeastern University, Fort Lauderdale, FL, USA 5 Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA 6 Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA * Corresponding author Received 23 January 2019 Accepted 11 February 2019 Available online 11 March 2019. Abstract Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder characterized by prolonged periods of fatigue, chronic pain, depression, and a complex constellation of other symptoms. Currently, ME/CFS has no known cause, nor are the mechanisms of illness well understood. Therefore, with few exceptions, attempts to treat ME/CFS have been directed mainly toward symptom management. These treatments include antivirals, pain relievers, antidepressants, and oncologic agents as well as other single-intervention treatments. Results of these trials have been largely inconclusive and, in some cases, contradictory. Contributing factors include a lack of well-designed and -executed studies and the highly heterogeneous nature of ME/CFS, which has made a single etiology difficult to define. Because the majority of single-intervention treatments have shown little efficacy, it may instead be beneficial to explore broader-acting combination therapies in which a more focused precision-medicine approach is supported by a systems-level analysis of endocrine and immune co-regulation.