Suggested pharmacological interventions based on literature review data for patients with debilitating fatigue and/or severely reduced health-related quality of life#
| Not receiving immunosuppressive agents | Receiving first-line immunosuppressive agent | Optimally treated with first- to third-line immunosuppressive agents | ||
| Disease activity present¶ | Yes | Initiate trial of first-line immunosuppressive agent | Switch to trial of second- or third-line immunosuppressive agent | Initiate trial of stimulant |
| No | Initiate trial of stimulant | Initiate trial of stimulant |
#: After exclusion of other causes of fatigue (e.g. depression, thyroid dysfunction, sleep apnoea, vitamin D deficiency), consideration of non-pharmacological interventions (e.g. physiotherapy), and careful shared decision making weighing pros and cons together with the patient. ¶: Based on clinical symptoms and/or disease activity markers.