Julie Rehmeyer's 'Through the Shadowlands'
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Rituximab in CFS - as a psychotherapy.

Discussion in 'Rituximab: News and Research' started by RogerBlack, Jul 30, 2017.

  1. RogerBlack

    RogerBlack Senior Member

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    Assuming for the moment that you believe CFS is entirely according to the fear-avoidance model, and ...
    Has anyone compared the efficacies of it in the phase II trial, compared with the various CBT approaches.
    They are both (if you believe in the BPS model) cognitive/placebo driven unblinded trials.

    I don't of course believe this is the mechanism of action, but was idly wondering how it would compare if you treated it as a placebo effect driven treatment, with regards to cost-efficacy and ...
     
  2. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    The phase II trial was blinded so the difference between rituximab and control cannot easily be considered a placebo effect.
     
  3. JES

    JES Senior Member

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    Furthermore, it seems that the majority of people responded around the 6 months mark after receiving their first Rituximab infusion, so it would be very difficult to attribute a placebo effect to these improvements.
     
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  4. A.B.

    A.B. Senior Member

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    Assuming the phase 3 trial is positive, anyone that still thinks the challenge of treating ME/CFS effectively is that of generating the strongest placebo effect is making a fool of themselves.

    A positive result will change the game and former CBT/GETLP/etc proponents will have to either adapt and start treating the psychosocial problems that patients actually have or leave the ME/CFS field.
     
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  5. RogerBlack

    RogerBlack Senior Member

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    Oops - I thought the phase II was unblinded, but I was thinking of the 2015 paper, not the 2011 one.

    To ignore results of phase III tips over from the threadbare excuse territory, into active denialism. (which I expect, but hope is ignored).
     
  6. Londinium

    Londinium Senior Member

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    It is, however, a criticism that I imagine might be made around the Cyclophosphamide trial. I would think it's very difficult to argue proper double blinding around a drug like Cyclophosphamide given its side effects - which is why it's important that the team are also using objective measures in addition to self-report. And, unlike PACE, that these objective measures are in line with the self-reporting scores.

    (As noted above it's the delay in response that, to me, indicates it's unlikely to be placebo response, especially as in the first trial a response was expected earlier by the researchers than actually occurred - indeed, the trial was technically a failure when measured on its primary objective because it measured response too early).
     
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  7. tomcy6

    tomcy6

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    I think that by the time you get to Rituximab you will have tried so many treatments (prescription and nonprescription) and had so many changes in symptoms that your placebo effect capacity will have been used up.
     
  8. Kenny Banya

    Kenny Banya Senior Member

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    Australia
    Ha ha ha!!
    Brilliant!!!
    Stand up worthy material !!!!
     
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  9. Kenny Banya

    Kenny Banya Senior Member

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    Taking this logic to its conclusion, we might as well label any successful treatment for any disease as potentially the placebo effect.
    But then, that is why we have treatment, placebo & no treatment groups & test the data for statistical significance (off the top of my head they will be using a Repeated Measures ANOVA for this drug trial).
     

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