Improvement in fatigue during Natalizumab treatment is linked to improvement in depression and day-time sleepiness

• Main Authors: Iris-Katharina ePenner, Eva Catharina eSivertsdotter, Elisabeth G eCelius, Siegrid eFuchs, Karen eSchreiber, Sara eBerko, Anders eSvenningsson
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2015-02-01
• Series: Frontiers in Neurology
• Subjects: Depression; Fatigue; multiple sclerosis (MS); sleepiness; treatment response
• Online Access: http://journal.frontiersin.org/Journal/10.3389/fneur.2015.00018/full

Background: Fatigue is a frequent symptom in multiple sclerosis (MS) and often interrelated with depression and sleep disorders making symptomatic treatment decisions difficult. In the single-arm, observational phase IV TYNERGY study, relapsing-remitting MS patients showed a clinically meaningful decrease in fatigue over one year of treatment with natalizumab. Objective: To evaluate whether fatigue improvement might be directly linked to improved depression and daytime sleepiness. Methods: Patients were assessed regarding fatigue, depression, and daytime sleepiness. The relation between changes of the two latter symptoms and changes in fatigue was analysed. Results: After one year of natalizumab treatment, the majority of patients (>92%) remained stable or improved in total, motor and cognitive fatigue. Proportion of patients without depression increased by 17% while proportions of mildly depressed patients or patients with potential major depression decreased by 5% and 12%, respectively. Proportion of patients classified as not being sleepy increased by 13% while proportions of sleepy and very sleepy patients decreased by 11% and 2%, respectively. Most importantly, improved depression and sleepiness were significantly related to improved fatigue. Conclusion: Our findings highlight the importance of patient-reported outcomes in identifying potential benefits of drug treatment beyond its well-established effects on disease activity and disability progression.