Chronisch Vermoeidheidssyndroom: diagnose, behandeling en ...

KCE Reports 88 Chronic Fatigue Syndrome 47
2.5.3.6 Supplement treatments
Eleven studies were reviewed in CRD Report 35 that investigated supplement
treatments for CFS patients. Only three of these studies investigating either essentially
fatty acids or magnesium were of high quality (1A).
No significant effects were noted in RCTs of general supplements, pollen extract and
medicinal mushrooms. A RCT of acclydine and amino acids reported significantly more
improvement in IGF-1 levels in the intervention than control group, but no significant
difference in global improvement or symptoms (p < 0.0001).
Studies that examined essential fatty acid supplements were conflicting, with one high
quality RCT (1A; n=50) reporting no improvement and one slightly larger controlled
trial (1A; n=63) conducted in patients with post-viral fatigue syndrome (PVFS) reporting
an overall beneficial effect. This trial showed greater shifts towards normal levels of cell
fatty acid concentration in treatment groups, most of which were statistically significant,
as well as improvements in symptom measures.
One small RCT (1A; n=34) showed that magnesium supplements had an overall positive
effect of improvement in measures of energy and pain, emotional reactions, general
health and laboratory measures, but not in sleep, physical mobility or social isolation.
However, two of 34 participants in this study dropped out, 1 because of generalised
rash.
One very small RCT (1B) assessed the effects of liver extract in patients with CFS but
found no difference in outcomes (activity and energy, mental health, symptoms)
between the intervention and control groups.
A RCT of acetyl-L-carnitine and propionyl-L-carnitine (1A) found significant
improvements in fatigue and cognitive function associated with treatment. Adverse
effects of supplement trials are not well reported as well as reasons for dropping out of
the studies (except for magnesium).
Beyond RCTs included in Bagnall’ systematic review, McDermott et al. 130 compared a
food supplement, the arabinoxylane (BioBran MGN-3) versus placebo for 8 weeks in 71
CFS adult patients. Data were complete in 64/71 patients. Both groups showed marked
improvement over the study duration, but without significant differences, except for the
social well-being subscale of the WHOQOL-BREF, where improvement was significantly
better in the placebo group. There was no significant difference between groups in
fatigue severity (change in Chalder physical fatigue subscale from baseline to 8 weeks: -
1.5 with BioBran v -1.8 with placebo; difference -0.3, 95% CI -3.2 to + 2.6; p = 0.84). No
serious adverse effects were reported. Three people on active treatment withdrew
because of minor side-effects (mild nausea, exacerbation of fatigue, and irritable bowel
symptoms, respectively) and one person withdrew from the placebo group because of
worsening fatigue (p value not provided).
Another recent RCT assessed the effect of Acclydine on fatigue severity, functional
impairment, and biologically active IGF1 level (IGFBP3/IGF1 ratio) in CFS adult
patients. 131 No differences were found in IGF1 status in CFS patients compared to
healthy matched neighbourhood controls. In addition, the results of this clinical trial do
not demonstrate any benefit of Acclydine over placebo in the treatment of CFS. The
negative results of this trial are important: Acclydine is expensive and is available
without prescription on the Internet, making it available to patients potentially without a
doctor’s oversight.
Evidence is insufficient to support a beneficial effect of dietary supplements,
including essential fatty acids in CFS (Evidence quality 1A).
2.5.3.7 Other treatments
One controlled trial of combination treatment (including medical treatment of
symptoms plus anxiety/affective disorder and CBT) in patients with CFS was also
included in the CRD Report 35. 1 This controlled trial included 71 patients, but only 22
of the 71 original participants were followed up (17 in the intervention group and 5 in
the control group).