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. 2021 Dec 2;21(1):468.
doi: 10.1186/s12883-021-02396-1.

Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review

Abril Oliva Ramirez  1 , Alexander Keenan  2 , Olivia Kalau  1 , Evelyn Worthington  1 , Lucas Cohen  1 , Sumeet Singh  1
Affiliations

Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review

Abril Oliva Ramirez et al. BMC Neurol. .

Abstract

Background: Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS).

Methods: Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data.

Results: The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS.

Conclusion: Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.

Keywords: Burden of illness; Economic; Fatigue; Multiple sclerosis; Prevalence; Quality of life; Systematic review.

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Conflict of interest statement

AOR, OK, EW, LC, and SS have disclosed that they are employees of EVERSANA, which received consulting fees from Janssen Research & Development, LLC in connection with the development of this manuscript. AK is employed by Janssen Research & Development, LLC. AK has disclosed that he is also a shareholder of Janssen Research & Development, LLC.

Figures

Fig. 1
Fig. 1
Search and exclusion process. a Searches were run separately for (1) epidemiology (n = 3172) and (2) economic/QoL studies (n = 3258). Each search was then deduplicated (epidemiology = 3081; economic/QoL = 3229). The two searches were then combined and deduplicated once again (n = 4631). b In some cases, more than one record was identified for a given study/population. c Supplemental search of economic studies with fatigue measured as a continuous parameter. Abbreviations: MA = meta-analysis; NMA = network meta-analysis; QoL = quality of life; SLR = systematic literature review
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