Pharmacological approaches for which there is no evidence of benefit
None of these interventions are recommended but practitioners should be aware of them so that they can address patients’ concerns and questions. If patients are taking dietary supplements and they are feeling benefit and if the intervention is not toxic or too expensive then it seems reasonable to acquiesce in their use but these interventions cannot be recommended nor made available on the NHS. Practitioners should note that there is no evidence that dietary supplements are effective.
Rituximab: Rituximab primarily destroys B cells and is therefore used to treat diseases which are characterized by excessive numbers of B cells, overactive B cells, or dysfunctional B cells, including auto-immune conditions.
A recent publication from Norway stated that in a study they had conducted there were beneficial effects of Rituximab on CFS/ME patients. If these effects are real and can be reproduced, the findings may guide us to understanding what causes CFS/ME.
Criticisms of the Norwegian study, some alluded to by the authors themselves, included the small number of patients participating in the study, and the high incidence of auto-immune illness already existing in the CFS/ME patients, or in their families. In addition, some of the tests and parameters used to measure the effects of treatment with Rituximab have not been used widely in previous trials, some of the methods used could have introduced bias, and statistical findings have been called into question. Finally, one of the major findings, the delayed response to reduction in fatigue by participants in this study, in comparison to the immediate response in all other auto-immune conditions in which depletion of B cells by Rituximab is used, has not been explained adequately.