The power and pitfalls of omics part 2: epigenomics, transcriptomics and ME/CFS
Simon McGrath concludes his blog about the remarkable Prof George Davey Smith's smart ideas for understanding diseases, which may soon be applied to ME/CFS.
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BMJ: Updated 'clinical evidence' on treatment of ME/CFS (25 Sep 2015)

Discussion in 'General ME/CFS Discussion' started by charles shepherd, Sep 29, 2015.

  1. charles shepherd

    charles shepherd Senior Member

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    Last edited: Sep 29, 2015
  2. charles shepherd

    charles shepherd Senior Member

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    Overview
    General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as previous version of this BMJ Clinical Evidence systematic overview.

    General background
    Chronic fatigue syndrome (CFS) is characterised by severe, disabling fatigue and other symptoms, including musculoskeletal pain, sleep disturbance, impaired concentration, and headaches. The two most widely used definitions of CFS are from the Centers for Disease Control and Prevention (CDC) and the Oxford criteria. The principal difference between these definitions is the number and severity of symptoms, other than fatigue, that must be present.

    For this update, the focus was on treatments that had the best evidential support in previous editions, that are in widespread clinical use, and/or have recent trial data.


    Comments on evidence
    There is good-quality evidence that both cognitive behavioural therapy (CBT) and graded exercise therapy are effective treatments for reducing fatigue and increasing functional capacity in people with CFS. There is less evidence for the drug treatments considered in this overview (antidepressants and corticosteroids); in particular, the evidence for corticosteroid use in people with CFS is limited. Several different instruments were used across studies to measure our outcomes of interest. Some of these involved self-rating by the person with CFS, whereas others report clinician-rated outcomes (in which case the assessor should be blinded). We have not reported school attendance as a main outcome in this overview, however, if available, we have added this data to the relevant Further information on studies section. Most studies were quite short-term; we only found one study with follow-up beyond 12 months.


    Search and appraisal summary
    The update literature search for this overview was carried out from the date of the last search, March 2010, to November 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 169 studies. After deduplication and removal of conference abstracts, 86 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 71 studies and the further review of 15 full publications. Of the 15 full articles evaluated, two systematic reviews, one RCT, and one further follow-up report of an RCT were added at this update.


    Additional information
    The largest RCT to date found that CBT and graded exercise therapy are more effective than adaptive pacing therapy or specialised medical care. While antidepressants may not be effective for CFS per se, they should be considered for patients with depressive disorders. Tricyclic antidepressants, in particular, should be considered in patients with chronic joint and/or muscle pain given their additional analgesic properties.

    For this update, the focus was on treatments that had the best evidential support in previous editions, that are in widespread clinical use, and/or have recent trial data.

    Substantive changes at this update
    Cognitive behavioural therapy Two systematic reviews,[34][35] one RCT,[46] and a further longer term follow-up report added.[45] Categorisation unchanged (beneficial).

    Graded exercise therapy Two systematic reviews [34][35] and one RCT added.[46] Categorisation unchanged (beneficial).



    ABSTRACT

    INTRODUCTION: Chronic fatigue syndrome affects between 0.006% and 3% of the population depending on the criteria of definition used, with women being at higher risk than men.

    METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected treatments for chronic fatigue syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).

    RESULTS: At this update, searching of electronic databases retrieved 169 studies. After deduplication and removal of conference abstracts, 86 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 71 studies and the further review of 15 full publications. Of the 15 full articles evaluated, two systematic reviews, one RCT, and one further follow-up report of an RCT were added at this update. We performed a GRADE evaluation for 23 PICO combinations.

    CONCLUSIONS: In this systematic overview, we categorised the effectiveness of four interventions based on information relating to the effectiveness and safety of antidepressants, cognitive behavioural therapy, corticosteroids, and graded exercise therapy.
     
  3. Sasha

    Sasha Fine, thank you

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    Who is the author?
     
  4. charles shepherd

    charles shepherd Senior Member

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    Valentijn, Sasha and Scarecrow like this.
  5. JamBob

    JamBob Senior Member

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  6. Scarecrow

    Scarecrow Revolting Peasant

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    What a shame. Can't wait to find out what the "good quality evidence" is for CBT and GET.
     
    MeSci, maryb, Cheshire and 2 others like this.
  7. Scarecrow

    Scarecrow Revolting Peasant

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    Bizarrely, I actually am laughing. Between this, rituximab and the recent autoantibody paper, we're on quite a rollercoaster.
     
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  8. ScottTriGuy

    ScottTriGuy Stop the harm. Start the research and treatment.

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    The harm by the allo medical system just keeps coming.

    One day, soon, they will hang their heads with shame.

    And, I for one, will pointing them out for ridicule.
     
    maryb likes this.
  9. Scarecrow

    Scarecrow Revolting Peasant

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    What's going on at the BMJ? A few months ago we had that terrible Andrew Lloyd opinion piece and now this.
     
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  10. charles shepherd

    charles shepherd Senior Member

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  11. Chrisb

    Chrisb Senior Member

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    I thought a certain Wessely S had let it be known that he had withdrawn from any interest in this field. One suspects that somewhere there must be a monkey calling upon his cat to go and get its paw burned again.
     
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  12. Sean

    Sean Senior Member

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    Is that CDC the 1994 Fukuda?

    Is it actually true that the Oxford is the (presumably) second most cited criteria?

    Nice work if you can get it, reviewing your own competence and career. :whistle:
     
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  13. Scarecrow

    Scarecrow Revolting Peasant

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    I presume it would be for research. What other definition is any self-respecting, BPS ideology-espousing researcher going to use?
     
  14. Sasha

    Sasha Fine, thank you

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  15. Sidereal

    Sidereal Senior Member

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    "May not"? I am not aware of any shred of evidence that they may be effective. Lots of anecdotal evidence of harm, however.
     
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  16. Apple

    Apple Senior Member

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  17. Scarecrow

    Scarecrow Revolting Peasant

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    Ah, ha!

    This is a systematic review of CFS.
    Nowhere is ME, myalgic encephalomyelitis, CFS/ME or ME/CFS mentioned in the summary. You'd think they could have found space for a quick 'aka'.

    Wiggle room?
     
    maryb, halcyon, alkt and 4 others like this.
  18. Sean

    Sean Senior Member

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    They are trying to differentiate and bargain: 'Give us a few CF / CFS patients to terrorise play with therapeuticise, and we will cede ME / SEID to the biomedical guys.'

    Which does rather beg the question about how these (allegedly) different groups of patients are distinguished retrospectively for existing studies? Who gets to cite what?
     
    maryb, justy, Woolie and 7 others like this.
  19. alex3619

    alex3619 Senior Member

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    Must be more of the stuff they didn't publish from the PACE trial? (sarcasm) :confused:
     
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  20. A.B.

    A.B. Senior Member

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    They're reviewing their own work. I expect any criticism to be absent. As usual I think they also won't acknowledge any biomedical research that might cast doubt on their psychosocial narrative of CFS.
     
    maryb, mango, Kati and 10 others like this.

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