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 agentsReceiving first-line immunosuppressive agentOptimally treated with first- to third-line immunosuppressive agents
Disease activity presentYesInitiate trial of first-line immunosuppressive agentSwitch to trial of second- or third-line immunosuppressive agentInitiate trial of stimulant
NoInitiate trial of stimulantInitiate 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.