Long-term effect of CBT and doxycycline treatment for patients with Q fever fatigue syndrome

[Murph]

J Psychosom Res. 2019 Jan;116:62-67. doi: 10.1016/j.jpsychores.2018.11.007. Epub 2018 Nov 12.
Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study.
Raijmakers RPH1, Keijmel SP2, Breukers EMC3, Bleijenberg G4, van der Meer JWM5, Bleeker-Rovers CP6, Knoop H7.
Author information

Abstract
BACKGROUND:
Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial.

METHODS:
All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity.

RESULTS:
Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2-42.9] and 31.3 [95% CI, 27.5-35.1], mean difference 8.2 [95% CI, 4.9-11.6]; P < .001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1-43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5-44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6-40.7]; P = .92 and P = .38, respectively).

CONCLUSION:
The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.

Copyright © 2018 Elsevier Inc. All rights reserved.

KEYWORDS:
Cognitive behavioural therapy; Coxiella burnetii; Doxycycline; Follow-up; Q fever fatigue syndrome; Therapy

PMID:

30654996

DOI:

10.1016/j.jpsychores.2018.11.007

 

[Murph]

"Our talk therapy has no long-term effect.

...We recommend talk therapy."

 

[Murph]

credit to them for doing a follow up and actually publishing it when it showed negative results. This is actually good science.

 

[percyval577]

At least it indicates that people in generel like to talk about their lives.


[ Great discovery.]

 

[roller]

what? i hope i misunderstand what they say.

i never thought, that CBT was to reduce fatigue. but for easing the daily routines a little.

and that doxycycline didnt help???
i cant believe this at all.
even for fatigue doxy should have at least a small improvement.
actually, imo a remarked improvement even.

 

[percyval577]

@roller ,
I had some small dosage doxycycline (only 50mg) for my rosacea.
But it didn´t work, so I stopped it.

Later, when I was/am slowly improving with my mecfs (after an intermediate very good imrovement for three month),
I took this doxycyycline for my mecfs now,
and got a very good effect -

but only for three times, first intake day 1, second intake day 4, thrid intake day 7.
and than it stopped and never came back.

 

[Mel9]

J Psychosom Res. 2019 Jan;116:62-67. doi: 10.1016/j.jpsychores.2018.11.007. Epub 2018 Nov 12.
Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study.
Raijmakers RPH1, Keijmel SP2, Breukers EMC3, Bleijenberg G4, van der Meer JWM5, Bleeker-Rovers CP6, Knoop H7.
Author information

Abstract
BACKGROUND:
Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial.

METHODS:
All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity.

RESULTS:
Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2-42.9] and 31.3 [95% CI, 27.5-35.1], mean difference 8.2 [95% CI, 4.9-11.6]; P < .001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1-43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5-44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6-40.7]; P = .92 and P = .38, respectively).

CONCLUSION:
The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.

Copyright © 2018 Elsevier Inc. All rights reserved.

KEYWORDS:
Cognitive behavioural therapy; Coxiella burnetii; Doxycycline; Follow-up; Q fever fatigue syndrome; Therapy

PMID:

30654996

DOI:

10.1016/j.jpsychores.2018.11.007

These researchers seem quite deluded. They seem to think that Q fever is psychosomatic!

 

[msf]

"Our talk therapy has no long-term effect.

...We recommend talk therapy."

Don't be ridiculous! They aren't advocating a non effective therapy, they are advocating one WORSE than placebo! If you think we deserve therapies that are as good as placebo then you probably need CBT.

(I'm just pretending to be as big as a ****wit as the people who wrote this paper).

 

[msf]

I can't find their first paper, and am doubting they ever published their results. There really is no word to describe such unethical, unscientific and illogical research. The best I can come up with is quackery.

 

[msf]

Ah, I see it wasnt significantly worse than placebo in the long term. Well that is an encouraging trend.

 

[roller]

https://www.ncbi.nlm.nih.gov/pubmed/28329131

Clin Infect Dis. 2017 Apr 15;64(8):998-1005. doi: 10.1093/cid/cix013.
Effectiveness of Long-term Doxycycline Treatment and Cognitive-Behavioral Therapy on Fatigue Severity in Patients with Q Fever Fatigue Syndrome (Qure Study): A Randomized Controlled Trial.
Keijmel SP1,2, Delsing CE3, Bleijenberg G4, van der Meer JWM1,2, Donders RT5, Leclercq M6, Kampschreur LM7, van den Berg M8, Sprong T2,9, Nabuurs-Franssen MH10, Knoop H4,11, Bleeker-Rovers CP1,2.
Author information

Abstract
BACKGROUND:
Approximately 20% of patients with acute Q fever will develop chronic fatigue, referred to as Q fever fatigue syndrome (QFS). The objective of this randomized controlled clinical trial was to assess the efficacy of either long-term treatment with doxycycline or cognitive-behavioral therapy (CBT) in reducing fatigue severity in patients with QFS.

METHODS:
Adult patients were included who met the QFS criteria according to the Dutch guideline: a new onset of severe fatigue lasting ≥6 months with significant disabilities, related to an acute Q fever infection, without other somatic or psychiatric comorbidity explaining the fatigue. Using block randomization, patients were randomized between oral study medication and CBT (2:1) for 24 weeks. Second, a double-blind randomization between doxycycline (200 mg/day, once daily) and placebo was performed in the medication group. Primary outcome was fatigue severity at end of treatment (EOT; week 26), assessed with the Checklist Individual Strength subscale Fatigue Severity.

RESULTS:
Of 155 patients randomized, 154 were included in the intention-to-treat analysis (doxycycline, 52; placebo, 52; CBT, 50). At EOT, fatigue severity was similar between doxycycline (40.8 [95% confidence interval {CI}, 37.3-44.3]) and placebo (37.8 [95% CI, 34.3-41.2]; difference, doxycycline vs placebo, -3.0 [97.5% CI, -8.7 to 2.6]; P = .45). Fatigue severity was significantly lower after CBT (31.6 [95% CI, 28.0-35.1]) than after placebo (difference, CBT vs placebo, 6.2 [97.5% CI, .5-11.9]; P = .03).

CONCLUSIONS:
CBT is effective in reducing fatigue severity in QFS patients. Long-term treatment with doxycycline does not reduce fatigue severity in QFS patients compared to placebo.

CLINICAL TRIALS REGISTRATION:
NCT01318356.

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com

KEYWORDS:
Coxiella burnetii; Q fever fatigue syndrome.; cognitive-behavioral therapy; doxycycline; placebo
PMID: 28329131
DOI: 10.1093/cid/cix013

 

[gbells]

"Our talk therapy has no long-term effect.

...We recommend talk therapy."

If it doesn't work but we still get paid keep doing it.