A recent study led by the University of Michigan indicates that both pharmacological and behavioral interventions, specifically modafinil and cognitive behavioral therapy (CBT), offer significant relief from fatigue in individuals with multiple sclerosis (MS). The randomized clinical trial, published in The Lancet Neurology, compared the effectiveness of modafinil and CBT in reducing fatigue among over 300 adults with MS whose fatigue interfered with daily activities.
Comparative Effectiveness of Modafinil and CBT
The study revealed that treatment with either modafinil or CBT alone led to substantial reductions in fatigue over a 12-week period. Notably, a combination of both treatments did not result in superior fatigue scores compared to the individual interventions. This suggests that both approaches are comparably effective in managing MS-related fatigue.
"Fatigue is one of the most common and debilitating symptoms of multiple sclerosis, yet there is still uncertainty about how available treatments should be used or how medication-based treatments compare to behavioral treatments in the real world," said Tiffany J. Braley, M.D., M.S., director of the Multiple Sclerosis/Neuroimmunology Division at University of Michigan Health.
Study Design and Findings
The research employed a real-world approach, closely mirroring clinical practice. Over 60% of participants in each treatment group reported clinically meaningful improvement in fatigue, as measured by the Modified Fatigue Impact Scale. The study also included a follow-up appointment 12 weeks after the treatments ended, where participants who received only CBT maintained lower fatigue scores.
Anna L. Kratz, Ph.D., professor of physical medicine and rehabilitation at U-M Medical School, noted, "These treatments, both individually and as a combination, should be considered as potential options for people with multiple sclerosis with chronic, problematic fatigue."
Impact of Sleep Hygiene
Interestingly, the study found that participants' sleep habits influenced the effectiveness of the treatments. Those with poor sleep hygiene tended to have better fatigue outcomes with CBT, while participants with very good sleep hygiene showed better fatigue outcomes with modafinil. This suggests that behavioral treatments like CBT, which include sleep education, may be preferable for MS patients with poor sleep habits.
Implications for Treatment
The findings highlight the importance of shared decision-making in treatment selection, considering patient characteristics and broader treatment goals. With up to 90% of the nearly 3 million people with MS worldwide experiencing fatigue, and nearly half describing it as their most disabling symptom, these results offer valuable insights into managing this challenging aspect of the disease.
