Study summary · research use only
Managing fatigue in sarcoidosis - A systematic review of the evidence
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This systematic review (species: human) searched Medline and Web of Science through November 2015 for studies of interventions on fatigue scores in patients with sarcoidosis. Eight studies were identified, evaluating six different interventions: infliximab, adalimumab, ARA 290, methylphenidate, armodafinil, and exercise programmes. The authors describe evidence of a treatment effect for anti-tumour necrosis factor (TNF)-α therapies (adalimumab and infliximab) and for neurostimulants (methylphenidate and armodafinil), but note that five of the studies had high risk of bias across most domains and the remaining three studies were small and short in duration. The review states that trial evidence for treating sarcoidosis-associated fatigue is limited and needs further investigation, and that further study of neurostimulants is needed.
Abstract
Fatigue is a common manifestation of sarcoidosis, often persisting without evidence of disease activity. First-line therapies for sarcoidosis have limited effect on fatigue. This review aimed to assess the treatment options targeting sarcoidosis-associated fatigue. Medline and Web of Science were searched in November 2015; the bibliographies of these papers, and relevant review papers, were also searched. Studies were included if they reported on the efficacy of interventions (both pharmacological and non-pharmacological) on fatigue scores in sarcoidosis patients. Eight studies were identified that fulfilled the inclusion criteria. These studies evaluated six different interventions (infliximab, adalimumab, ARA 290, methylphenidate, armodafinil and exercise programmes). There is evidence to support a treatment effect of anti-tumour necrosis factor (TNF)-αtherapies (adalimumab and infliximab) and neurostimulants (methylphenidate and armodafinil), but within five of the studies, the risk of bias was high within most domains and the remaining three studies included only small numbers of participants and were short in duration. Trial evidence for treating fatigue as a manifestation of sarcoidosis is limited and requires further investigation. Anti-TNF-α therapies may be beneficial in patients with organ-threatening disease. Neurostimulants have some trial evidence supporting improvements in fatigue but further investigation is needed before they can be recommended.
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