Fatigue bei therapierten und untherapierten Patienten mit schubförmiger und sekundär progredienter Multipler Sklerose

Zusammenfassung

Hintergrund Fatigue ist eines der häufigsten und beeinträchtigendsten Symptome bei multipler Sklerose (MS). Die Ursachen für Fatigue sind weitgehend unklar. Ziel dieser Studie ist, die Prävalenz und Schwere von Fatigue unter den verschiedenen krankheitsmodifizierenden Therapien zu untersuchen. Methode Epidemiologische Querschnittsuntersuchung an 343 konsekutiven MS-Patienten zwischen November 2003 und Oktober 2004. Fatigue wurde mittels Fatigue Severity Scale (FSS) gemessen. Die Analyse umfasst Patienten mit schubförmiger oder sekundär progredienter MS. Die 3 Behandlungsgruppen (keine Therapie, Immunmodulation, Immunsuppression) wurden mittels univariater Analyse mit dem FSS korreliert. Um mögliche Effekte von Alter, Geschlecht, Verlaufsform, Schubrate, Krankheitsdauer, neurologischem Status in Form von der Expanded Disability Status Scale (EDSS) auszuschließen wurde eine rückwärtsgerichte logistische Regressionsanalyse durchgeführt. Ergebnisse 242 Patienten wurden in diese Analyse eingeschlossen. Die Prävalenz von schwerer Fatigue (FSS ≥ 5) war 51 %. In der multivariaten Regressionsanalyse (kontrolliert für Alter, MS-Typ, MS-Dauer und Behinderung) fand sich keine signifikante Assoziation zwischen dem Einsatz immunsuppressiver und immunmodulatorischer Therapien und Fatigue im Vergleich zu keiner Therapie (OR 1,34; p = 0,38 für Immunsuppression und OR 0,95; p = 0,85 für Immunmodulation). Schlussfolgerung Obwohl die krankheitsmodifizierende Therapie bei MS die klinische und subklinische Krankheitsaktivität reduziert, scheint sie keinen Einfluss auf Prävalenz und Schwere der Fatigue-Symptomatik zu haben.

Abstract

Background Fatigue is one of the most common and disabling symptoms in multiple sclerosis (MS). The pathophysiology of fatigue is not fully understood. The aim of this study was to investigate a possible association between MS-related fatigue syndrome and disease modifying therapy. Methods A cross-sectional study in 343 consecutive patients with MS between Nov 2003 and Oct 2004 was undertaken. Fatigue was assessed with the Fatigue Severity Scale (FSS). This analysis compromises patients with relapsing-remitting and secondary progressive MS. Three treatment groups („no therapy”, „immunomodulation” and „immunosuppression”) were correlated with FSS by univariate analysis. We performed a stepwise backward logistic regression analysis to evaluate interaction with age, sex, course of disease, relapse rate, duration of disease or disability assessed by the Expanded Disability Status Scale (EDSS). Results We included 242 patients in this analysis. The prevalence of severe fatigue (FSS ≥ 5) was 51 %. In a multivariate logistic regression analysis controlled for age, course of disease, duration of disease and EDSS) there was no significant association between „no treatment”, „immunomodulation”, „immunosuppression” and fatigue (OR 1.34, p = 0.38 for immunosuppression and OR 0.95, p = 0.85 for immunomodulation). Conclusions Although disease-modifying therapies in MS effectively reduce disease activity, they do not appear to have an significant effect on MS-related fatigue.

Schlüsselwörter

Multiple Sklerose - Fatigue - Therapie - Fatigue Severity Scale

Key words

multiple sclerosis - fatigue - therapy - fatigue severity scale

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