Modafinil fails to improve fatigue
Modafinil, a drug used to treat daytime sleepiness, does not appear to improve fatigue in patients with multiple sclerosis, a trial has revealed. Aspirin, on the other hand, may reduce the severity of this symptom.
French researchers examined the effects of modafinil in 115 patients
with relapsing remitting or progressive MS who were also suffering from
chronic fatigue. They found that the drug was no better than placebo
at relieving self-reported fatigue symptoms. After 35 days of treatment,
both had improved mean scores on a modified fatigue impact scale (63.1±9.3
to 52.3±18.5 for modafinil vs 63.3±10 to 49.2±16.6
for placebo).
Although the researchers conclude that no benefit was detected for modafinil,
they say that an unpublished post hoc analysis did reveal an effect related
to sleepiness. “Among patients with excessive daytime sleepiness,
modafinil tended to provide more benefit than placebo on the physical
component of fatigue,” they say (Neurology 2005;64:1139).
In a second study (ibid, p1267), researchers observed an improvement
in patient scores during treatment with aspirin (1,300mg daily) compared
with placebo (P=0.043). Patients were treated with both aspirin and placebo
in the cross-over trial. Among the 26 patients who completed both phases,
10 (38.5 per cent) preferred aspirin whereas only one (3.9 per cent)
preferred placebo (P=0.012).
An accompanying editorial warns that the apparent benefit of aspirin
and the lack of benefit of modafinil may be related to their effects
on other MS symptoms. “It is not clear that patients adequately
distinguish effects of fatigue from motor impairment, cognitive impairment
and other symptoms,” the authors argue (ibid, p1111). |
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