Chronisch Vermoeidheidssyndroom: diagnose, behandeling en ...

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42 Chronic Fatigue Syndrome KCE reports 88 Summary of results for CBT and GET Effectiveness of CBT • CBT is effective on physical functioning (functional status, fatigue, pain), psychological state (depression, mood, anxiety, well-being; concentration disturbances in adults and adolescents), quality of life and general health (work and social adjustment, long term goals, global improvement); • CBT is not effective for all patients. It aims at reducing severity of symptoms, and if possible, to cure CFS patients. Modalities of treatments • Effectiveness of group’s therapy: only 1 good quality level RCT (evidence quality 1B) and a lower quality non-randomised waiting list controlled study (evidence quality 2B) were conducted, suggesting that group’s therapy was effective; however, the effectiveness was less effective than individual therapy to improve cognitive function, quality of life or employment status. More high quality trials are needed to recommend group therapy; • Modified CBT: mainly studies of lower quality evidence were conducted to assess the effectiveness of modified CBT in CFS patients. Only 1 high quality RCT found positive results for symptoms. A brief-CBT administered by GPs in a RCT of good quality level found no significant results in favour of the treatment group; • Primary care versus secondary care: only 1 RCT of high quality focused on CBT administered in an outpatient clinic by trained therapists (but nonexperienced with CFS patients); results were positive but the improvement was lower than in other trials when therapy was performed by highly trained and skilled therapists. Effectiveness of GET • GET is effective on fatigue, health-related quality of life and perceived functional capacity (questionnaire); • GET is not effective for all patients, and does not improve anxiety, depression and quality of sleep; there is no evidence that GET improves activity levels; • There is no evidence that GET may worsen outcomes. Combining CBT and GET • No study investigated the added value of the combination of these therapeutic strategies. There is no evidence that this combination could lead to a higher improvement in CFS symptoms. Combining these therapies should take into account incremental costs compared to incremental effectiveness (see chapter 3 on economic evaluation). Therapists • CBT and GET have to be performed by trained therapists having an experience with CFS patients (1 RCT and 1 non randomised waiting list study); • These therapies should be adapted to the patient’s age (particularly for children younger than 12 years), the severity of their CFS, their preferences and experiences, and the outcome of previous treatment(s); • Therapy manuals having proved their validity in scientific studies have to be available.
KCE Reports 88 Chronic Fatigue Syndrome 43 2.5.3.3 Immunological, antiviral and anti-microbial treatments Numerous studies have investigated the role of infections in the pathogenesis of CFS and various viruses and virus groups have been implicated in CFS at some time; these include Epstein-Barr virus (EBV), cytomegalovirus, parvovirus B19, Brucellae, Toxoplasma gondii, C. burnetii, C. pneumoniae, human herpes virus-6 (HHV-6), group B coxsackieviruses (CVB), human T cell leukaemia virus II-like virus, spumavirus, hepatitis C virus, human lentiviruses and herpes virus-7. 106 The possibility that CFS is associated with an infection has been established. 107,108 In their systematic review, Bagnall et al. 1 included RCTs which investigated the effects of different immunological or antiviral treatments on CFS patients: antihistamine (oral Terfenadine 109 ), antiviral (Acyclovir, 110 Gancyclovir, 111 Inosine Pranobex 112 ), immunomodulators (Immunoglobulin, 113-115 Interferon, 116 Alpha Interferon, 117 leucocyte extract, 85 Ampligen 118 ) and vaccine (Staphylococcus toxoid 119,120 ). The RCT which evaluated the antihistamine (oral Terfenadine) found no differences between the groups for any of the outcomes investigated (functional status and symptoms). Only small RCTs (n
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