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DGDispatch
Dexmethylphenidate Effective Against Fatigue in Sarcoidosis: Presented at CHEST
By John Gever
CHICAGO, IL -- October 25, 2007 -- Dexmethylphenidate hydrochloride (d-MPH) can be used to treat fatigue in patients with sarcoidosis, according to research presented here at CHEST 2007, the annual meeting of the American College of Chest Physicians.
In a randomised, placebo-controlled, double-blind, cross-over trial involving 10 sarcoidosis patients, d-MPH (Focalin(R)) decreased fatigue by 30% according to a standard patient self-reporting instrument.
Pulmonary function was improved in some patients as well, according to Robert P. Baughman, MD, Professor of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States, who presented the findings on October 23.
Most patients with sarcoidosis experience often disabling fatigue. Previous research has found that methylphenidate can relieve fatigue in sarcoidosis patients, and d-MPH (an enantiomerically pure version of methylphenidate) has done likewise for fatigue in cancer patients receiving chemotherapy. d-MPH may have some advantages over methylphenidate, Dr. Baughman, said, so his group sought to learn if it would be as effective in sarcoidosis-associated fatigue.
All patients in the trial had sarcoid lesions in the lungs and half in the skin; one or two patients each also had involvement of the eyes, heart, spleen, nervous system and lymphatic system.
Patients were initially assigned to receive 8 weeks of treatment with placebo or 5 mg of d-MPH twice daily. After a 1-week washout period, they switched over to the other treatment for 8 weeks.
Each week during the 20-week trial, patients completed two separate fatigue rating instruments, the Fatigue Assessment Score (FAS) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). The study also examined effects on 6-minute walking distance.
On both scales patients reported significant improvements in fatigue symptoms during d-MPH treatment compared with placebo after 8 weeks of treatment (P <.02 on FACIT-F, P <.005 on FAS).
Forced vital capacity, both in litres and as a percentage of the predicted value, increased significantly from baseline with d-MPH treatment but not with placebo, Dr. Baughman said.
Both placebo and d-MPH led to some improvement in 6-minute walking distance, but a greater improvement with the active drug; however, the differences were not statistically significant either from baseline or between placebo and d-MPH.
At the end of the study, while treatment was still blinded, patients were asked if they wanted to stay on either treatment, and nine out of 10 patients picked the d-MPH, Dr. Baughman said.
"In patients with sarcoidosis associated fatigue, therapy with d-MPH or similar agents may improve clinical symptoms and improve the patient's quality of life," the researchers concluded.
[Presentation title: A Randomized Double-blind, Placebo Controlled Trial of Dexmethylphenidate Hydrochloride (D-MPH) for Sarcoidosis-Associated Fatigue. Session 895]
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