Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis : Shim 2020

Sly Saint · Apr 27, 2020

authors
Joanna Shim, Linda E Dean, Maira Karabayas, Gareth T Jones, Gary J Macfarlane, Neil Basu
Published:
26 April 2020

Abstract
Objectives
Effective management of axial spondyloarthritis (axSpA)-related fatigue is a major unmet clinical need. Anti-TNF therapy may reduce fatigue levels, although any effect has yet to be definitively quantified and predictors of any such improvements are unknown.

Methods
The British Society of Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) prospectively recruited axSpA patients across the UK. Changes in fatigue levels (measured using the Chalder Fatigue Scale) >1 year were compared between those starting anti-TNF therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results were meta-analysed with the extant literature to calculate pooled estimates. Then, among those BSRBR-AS anti-TNF commencers with clinically relevant fatigue, baseline predictors of response were investigated.

Results
Of the 998 BSRBR-AS recruits with complete fatigue data, 310 were anti-TNF commencers. At 1-year follow-up, the former group reported a mean fatigue change of −2.6 (95% CI −4.1, −1.9) points while the latter reported a mean worsening of fatigue by 0.2 points. Following propensity score adjustment, those commencing anti-TNF therapy reduced fatigue by 3.0 points compared with those not. Of those with significant fatigue and commencing anti-TNF, poor sleep quality at baseline predicted fatigue improvement. In the meta-analysis, including 1109 subjects, treatment with anti-TNF therapy resulted in a significant improvement in fatigue [Standardized mean difference (SMD) = 0.36, 95% CI 0.15, 1.56].

Conclusion
Anti-TNF therapy results in a significant but modest reduction in fatigue amongst axSpA patients, with those reporting poor sleep quality most likely to report improvement. Effective management will likely require additional approaches.
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https://academic.oup.com/rheumatolo...3/rheumatology/keaa132/5825444?searchresult=1

heavily relies on Chalder Fatigue scale and cites PACE trial

For this study, our outcome of interest was fatigue, measured using the Chalder Fatigue Scale (CFS) [12]. This 11-item questionnaire is one of the most commonly employed measures of fatigue. Validated in both general and clinical populations [13], it examines physical and mental fatigue dimensions. Items are rated on a four-point (0–3) Likert scale (0 =‘better than usual’, 1 =‘no worse than usual’, 2 =‘worse than usual’ and 3 =‘much worse than usual’). The scores are totalled (0–33), with higher scores indicating greater fatigue. A reduction of ≥2 is considered clinically important when used to evaluate treatment response [14]. In addition, by dichotomizing individual question responses at the median, a bimodal fatigue score can be generated ranging from 0 to 11 to classify fatigue where >3 is considered to be clinically important [12].
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rvallee · Apr 27, 2020

For this study, our outcome of interest was fatigue, measured using the Chalder Fatigue Scale
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The 2 halves of this sentence are mutually exclusive.

Anyone who uses CFQ in research is wasting everyone's time and should not be on the receiving end of a single dollar of scarce research funding.

If you can't take this seriously just go home. Seriously, go tend your garden or whatever, stop wasting people's lives.

Snowdrop · Apr 27, 2020

For anyone new to the subject.
To find out why the Chalder Fatigue Scale is considered to not be of use see this thread:

https://www.s4me.info/threads/explo...ic-fatigue-syndrome-1998-morriss-et-al.11065/

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Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis : Shim 2020

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