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. 2023 Apr 18;9(2):20552173231167079.
doi: 10.1177/20552173231167079. eCollection 2023 Apr-Jun.

Severity and worsening of fatigue among individuals with multiple sclerosis

Amber Salter  1 , Alexander Keenan  2 , Hoa H Le  2 , Kavita Gandhi  3 , Maria Ait-Tihyaty  4 , Samantha Lancia  1 , Gary R Cutter  5 , Robert J Fox  6 , Ruth Ann Marrie  7   8
Affiliations

Severity and worsening of fatigue among individuals with multiple sclerosis

Amber Salter et al. Mult Scler J Exp Transl Clin. .

Abstract

Background: Fatigue is associated with reduced quality of life and social participation, and poor employment outcomes. However, most studies examining fatigue are limited by small sample sizes or short follow-up periods.

Objective: To characterize the natural history of fatigue.

Methods: The North American Research Committee on Multiple Sclerosis Registry participants with ≥7 years of longitudinal data between 2004 and 2019 and a relapsing disease course were included. A subset of participants enrolled within 5 years of diagnosis was identified. The Fatigue Performance Scale assessed fatigue and ≥1-point increase in Fatigue Performance Scale sustained at the next survey defined fatigue worsening.

Results: Of 3057 participants with longitudinal data, 944 were within 5 years of multiple sclerosis diagnosis. Most participants (52%) reported fatigue worsening during follow-up. Median time to fatigue worsening ranged from 3.5 to 5 years at lower levels of index fatigue. Fatigue worsening was associated with lower annual income, increasing disability, lower initial fatigue level, taking injectable disease-modifying therapies and increasing depression levels in the relapsing multiple sclerosis participants.

Conclusion: Most multiple sclerosis participants early in their disease suffer from fatigue and at least half reported fatigue worsening over time. Understanding factors associated with fatigue may help to identify populations most at risk of fatigue worsening will be informative for the overall management of patients with multiple sclerosis.

Keywords: Multiple sclerosis; North American Research Committee on Multiple Sclerosis; fatigue.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Amber Salter reports honoraria for consulting for Gryphon Bio, LLC and research funding from Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Consortium of MS Centers and the US Department of Defense. She is a member of the Editorial Board for Neurology. Dr Salter is a member of the Data and Safety Monitoring Board for Premature Infants Receiving Milking or Delayed Cord Clamping (PREMOD2), Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), Ocrelizumab for Preventing Clinical Multiple Sclerosis in Individuals With Radiologically Isolated Disease (CELLO), and Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD). Gary Cutter data/safety monitoring committees for AMO, BioLineRx, BrainStorm Cell Therapeutics, Galmed, Horizon, Hisun, Merck, Merck/Pfizer, OPKO Biologics, Neurim, Novartis, Orphazyme, Sanofi, Reata, Receptos/Celgene, Teva, NHLBI (Protocol Review Committee), NICHD (OPRU oversight committee); consulting/advisory boards for Biogen, Click Therapeutics, Genzyme, Genentech, GW, Klein Buendel, MedImmune, MedDay, Novartis, Osmotica, Perception Neuroscience, Recursion, Roche, Somahlution, and TG Therapeutics Robert J Fox has received personal consulting fees from AB Science, Biogen, Celgene, EMD Serono, Genentech, Genzyme, Immunic, Janssen, Novartis, Sanofi, and TG Therapeutics; has served on advisory committees for AB Science, Biogen, Genzyme, Immunic, Janssen, Novartis, Sanofi, and TG Therapeutics; and received a clinical trial contract and research grant funding from Biogen, Novartis, and Sanofi. Ruth Ann Marrie receives research funding from CIHR, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Foundation, Crohn's and Colitis Canada, National Multiple Sclerosis Society, CMSC, the Arthritis Society, and US Department of Defense. She is a co-investigator on a study funded in part by Biogen Idec and Roche (no funds to her/her institution). She is supported by the Waugh Family Chair in Multiple Sclerosis. Samantha Lancia has nothing to disclose. Alexander Keenan, Hoa H Le, Kavita Gandhi, and Maria Ait-Tihyaty are employees of Janssen Pharmaceuticals and may own stock in Johnson & Johnson.

Figures

Figure 1.
Figure 1.
Participant disposition.
Figure 2.
Figure 2.
Proportion of fatigue levels within the cohort participant characteristics. (A) gender, (B) race, (C) education level, (D) disease-modifying therapy, (E) relapse in the past 6 month, (F) employment status in the past 6 months. The percentage shown is based on the distribution of the Fatigue Performance scale by each level of the participant characteristic.
Figure 3.
Figure 3.
Fatigue worsening in early relapsing multiple sclerosis.
See this image and copyright information in PMC

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