TABLE 4

Summary of included study results: fatigue

First author [ref.]InterventionEvidence of treatment effectEffect: fatigueOverall risk of bias
Anti-TNF-α and IL-12 and -23 therapy
 Erckens [14]AdalimumabYesImprovement in fatigue: FAS score reduced from 31.1±11.1 (baseline) to 28.5±7.8 (6 months; p<0.01) to 28.9±10.0 (12 months; p<0.01)
21 out of 26 patients suffered from fatigue (FAS≥22); 14 out of 21 became less fatigued; 4 out of 21 remained stable
High
 Judson [17]Ustekinumab GolimumabNoNo improvements in FAS fatigue score in treatment arms relative to placeboUnclear
Corticosteroids and corticotropin
 Aggarwal [19]PrednisoloneYesImprovement in fatigue: FAS score reduced from 24 (19–30) to 21 (17–27); p=0.004
33 out of 51 of patients experienced pre-treatment fatigue (FAS≥22): 21 out of 33 improved by >4 points and 4/33 worsened by >4 points on FAS
High
 Baughman [20]RCIYesImprovement in fatigue severity in combined RCI group: decrease in FAS total score from 28 (15–46) to 26 (10–37) (week 7; ns) to 22 (11–42) (week 24; p=0.0067)High
Other immunosuppressive and/or immunomodulating therapies
 Heij [22]ARA 290NoIn both arms fatigue decreased to a similar extent (ns): FAS 37.9±2.6 to 33.3±2.8 (ARA 290) and 33.6±2.3 to 29.8±3.3 (placebo)Low
Stimulants
 Lower [24]d-MPHYesImprovement in fatigue in d-MPH treated group: FACIT-F on average 30 (p<0.001)
FACIT-F on average during placebo arm: 24.3±5.41
Improvement in fatigue in d-MPH treated group: FAS on average 27 (p<0.02).
FAS on average during placebo arm: 33.6±4.43
Low
 Lower [25]ArmodafinilYesImprovement in fatigue: change in FAS score versus baseline for armodafinil versus placebo: −2.5 (−10.2 to 0.8) versus 1.5 (−0.1 to 4.3) (4 weeks; p=0.0676) and −4.5 (−11.1 to 2.1) versus 3.5 (0.0 to 8.0) (8 weeks; p=0.0295)
Improvement in fatigue: change in FACIT-F score versus baseline for armodafinil versus placebo: 6 (−3.4 to 14.1) versus −6 (−9.1 to −1.9) (4 weeks; p=0.0149) and 9 (−0.2 to 17.0) versus −5 (−13.1 to 1.1) (8 weeks; p=0.0040)
Unclear

TNF: tumour necrosis factor; IL: interleukin; FAS: Fatigue Assessment Scale; RCI: repository corticotropin; ns: nonsignificant; d-MPH: dexmethylphenidate; FACIT-F: Functional Assessment of Chronic Illness Therapy Fatigue.