Intravenous cyclophosphamide in ME/CFS. An open-label phase II study

Posted on 05/04/2020 by wames

Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study by Ingrid G Rekeland, Alexander Fosså, Asgeir Lande, Irini Ktoridou-Valen, Kari Sørland, Mari Holsen, Karl J Tronstad, Kristin Risa, Kine Alme, Marte K Viken, Benedicte A Lie, Olav Dahl, Olav Mella and Øystein Fluge in Front. Med., 29 April 2020 [doi.org/10.3389/fmed.2020.00162]

 

Research abstract:

Introduction:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease with high symptom burden, of unknown etiology, with no established treatment. We observed patients with long-standing ME/CFS who got cancer, and who reported improvement of ME/CFS symptoms after chemotherapy including cyclophosphamide, forming the basis for this prospective trial.

Materials and methods:

This open-label phase II trial included 40 patients with ME/CFS diagnosed by Canadian criteria. Treatment consisted of six intravenous infusions of cyclophosphamide, 600–700 mg/m2, given at four-week intervals with follow-up for 18 months, extended to 4 years. Response was defined by self-reported improvements in symptoms by Fatigue score, supported by Short Form 36 (SF-36) scores, physical activity measures and other instruments. Repeated measures of outcome variables were assessed by General linear models. Responses were correlated with specific Human Leukocyte Antigen (HLA) alleles.

Results:

The overall response rate by Fatigue score was 55.0% (22 of 40 patients). Fatigue score and other outcome variables showed significant improvements compared to baseline. The SF-36 Physical Function score increased from mean 33.0 at baseline to 51.5 at 18 months (all patients), and from mean 35.0 to 69.5 among responders. Mean steps per 24 h increased from mean 3,199 at baseline to 4,347 at 18 months (all patients), and from 3,622 to 5,589 among responders. At extended follow-up to 4 years 68% (15 of 22 responders) were still in remission. Patients positive for HLA-DQB1*03:03 and/or HLA-C*07:04 (n = 12) had significantly higher response rate compared to patients negative for these alleles (n = 28), 83 vs. 43%, respectively. Nausea and constipation were common grade 1–2 adverse events. There were one suspected unexpected serious adverse reaction (aggravated POTS) and 11 serious adverse events in eight patients.

Conclusion:

Intravenous cyclophosphamide treatment was feasible for ME/CFS patients and associated with an acceptable toxicity profile. More than half of the patients responded and with prolonged follow-up, a considerable proportion of patients reported ongoing remission. Without a placebo group, clinical response data must be interpreted with caution. We nevertheless believe a future randomized trial is warranted.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02444091.

MEPedia:  Cyclo ME study   Cyclo ME study part A

Promising results from trial of cancer drug in ME/CFS – but results should be interpreted with caution, according to researchers from Haukeland University Hospital.

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Margaret, Countess of Mar, & ME advocate, retires

Posted on 05/04/2020 by wames

ME Research UK: The Countess of Mar – an Appreciation 1 May 2020

From 1st May 2020, when the Countess of Mar retires officially from the House of Lords after almost 45 years’ service, the ME community will be losing a champion of the first rank and a redoubtable campaigner for acceptance of the illness, for research and for the proper treatment from government and the NHS of those affected by ME.

The Countess (her title dates back to c1014 and is the oldest peerage title still extant in the United Kingdom and is held by her in her own right) was, until her retirement, the only hereditary peeress in the House of Lords. She was elected to serve as one of the ninety-two hereditary peers retained in the Lords and sat as a cross-bencher. Her departure is marked by an article in ‘The Daily Telegraph’ of 2nd May (paywall) in which, with typical good humoured directness, she says “I don’t want to be there past my best before date.”

On of the privileges of membership of the House is access to Ministers, politicians, and decision-makers which she utilised to the utmost and to the benefit of those affected by ME.

Her zeal for a revolution in the perception and treatment of ME/CFS stemmed from her own experience of organophosphate poisoning which led to autonomic dysfunction. Concern turned to action and she was a member of several European Community Select Committees – on the environment, agriculture and consumer protection, and secretary of the All-Party Parliamentary Group on Pesticides and Organophosphates and a leading light and vice-chair of the All-Party Parliamentary Group on ME.

In 2008 and under her chairmanship, she created the Forward-ME Group, which consists of a broad spectrum of charities and voluntary organisations. The Group’s aim is to promote effective joint working by organisations to maximise impact on behalf of all people with ME and CFS in the UK. From the first meeting, ME Research UK has been a member with our (now) Vice Chair Sue Waddle, a regular attendee.

There have been 50 Minuted Meetings of the Group since the inaugural one on 8 October 2008. The ethos follows that set out in the Opening Statement:

I do hope that all of us here today will develop a strategy for bringing together all those who suffer from ME or are supporters and that we can then move on to transform the ME scene.

It is undoubtedly true that the Group would not have benefited from the opportunity to quiz politicians and the likes of NICE Directors, Officers of various medical Royal Colleges, the CMO of Capita or the Chairman of Optimum Health Care without the leverage that an invitation from a peeress possesses. The speakers, it is fair to say, left meetings under no doubt what challenges were faced by those with ME/CFS due to the decisions/processes that the speakers’ organisations had made.

In the House, Hansard records 36 instances of the Countess speaking to the Chamber specifically about ME/CFS (since such records were indexed from 2006). This does not include contributions to debates regarding neurological conditions or concerning those affected my long-term chronic illnesses in general. The contributions run the full gamut of issues which affect the ME community – social security, personal independence payments, work capability assessments, children and young persons, as well research. Her comments on the PACE trial (6 February 2013), CBT (18 March 2013), and neurological conditions (11 October 2010) are especially noteworthy and informed, and reward a re-visit.

The opportunities offered at Forward-ME for collaboration is illustrated by the commissioning of a survey into the experiences of those with ME/CFS who were offered CBT and GET. The study (funded jointly by ME Research UK and the ME Association) was delivered to NICE as part of a submission to provide hard evidence of the results of both ‘treatments’ and its findings received much publicity and are oft quoted.

In their Lordships’ debate on ME on 2 June 2008 – over a decade before the historic Jan 2019 House of Commons one – the Countess elicited confirmation from the Government (the Parliamentary Under-Secretary of State, Department of Health, Lord Darzil of Denham) “My Lords, the Government accept the World Health Organisation’s classification of CFS/ME as a neurological condition of an unknown cause.” An acceptance which has been used to remind the Department of Work and Pension of the nature of the illness ever since.

Her activities have not been confined to the red benches either. The Countess has been a vociferous letter-writer in defence of those affected by the illness and in challenging misconceptions about the illness e.g. Dr S O’ Sullivan’s book ‘It’s All in Your Head: True Stories of Imaginary Illness’.

Her role has also led to invitations to speak at various events – the launch of the CMRC for example and, in March 2015, to the Royal Society of Medicine to contribute to a lecture on ‘ME/CFS: Frontiers‘. The aim was to give delegates, all members of the Royal Society of Medicine, “a rare opportunity to learn about ME/CFS from a clinical, scientific and political perspective.” Her speech included a quote from Frantz Fanon and was addressed to the medics present

Ladies and gentlemen, I know how very difficult it is to say ‘Sorry, I got it wrong’, especially when your whole career has been based on a particular belief. I have been told that, in medicine, nothing will change until the old guard moves on. The history of medicine is littered with instances of this phenomenon. It is my very sincere wish that the situation will change radically long before the changing of the guard.
Through her work, Margaret has spoken truth unto power and pointed out the injustices that surround ME/CFS and the treatment of those with the condition. Although she will be retiring from the House of Lords, we know that she will not be withdrawing from the fight and we are truly grateful for all that she has done (thus far!) Excepts from Her letter to the members of the Forward-ME Group is reproduced below.

Trustee, Prof Faisel Khan, with ME Research UK Vice-Chair Sue Waddle, Patron The Countess of Mar, and Trustee Jan McKendrick at the launch of the CMRC. Part of email from the Countess of Mar to Forward-ME Group members –

After a great deal of thought and with some initial regrets, I have finally bitten the bullet and have decided to retire as a member of the House of Lords with effect from 1 May. As you know, I haven’t been well for some time and, although I am much better than I was, I have realised that I cannot be relied upon to do my Parliamentary duties to the standard that I would wish. I also find the prospect of travelling and getting about the House daunting.

After reaching my 80th year and having been a member of the House for nearly 45 of those years I feel that, while enjoying the huge privilege that membership has afforded me, I have done my duty.…….. Looking back, I believe that between us we have managed to change the perception of ME by most of both the medical profession and the public. There is still some way to go before we know cause/s and cure, but we are well on the way to finding them. I am confident that the NICE guideline development group are determined to get the new ME/CFS guideline right. I suspect that when this is published much will change for people with ME.

Telegraph: I want to go out on a high’: Meet Parliament’s last Countess, 4 May 2020

…yet it was only after she suffered a catastrophic accident in 1989 that she fully realised the power of her peerage. The couple were ‘dipping’ sheep on their farm in the Malvern Hills when some of the organophosphate liquid splashed inside her Wellington boot. ‘Three weeks later it was as though I’d been poleaxed,’ she recalls.

The poisoning sparked 18 months of chronic fatigue syndrome (ME), which affected the Countess’s memory and speech. The experience prompted her to embark on a lifelong campaign for better awareness of the condition, dismissed by many at the time as ‘yuppy flu’. ‘Psychiatrists would say – it’s all in your head. They’d been working on the principle that everybody was a shirker or could be cured by a bit of cognitive behaviour therapy and exercise,’ she recalls.

It took nearly 30 years of campaigning but in 2018, NICE (the National Institute for Health and Care Excellence) agreed to rewrite the outdated guidelines around ME.

ME Association: Stalwart champion of the ME community retires after distinguished parliamentary career 1 May 2020

Action for ME: Countess of Mar retires: share your message of thanks, 4 may 2020

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A systematic review of neurological impairments in ME/CFS using neuroimaging techniques

Posted on 05/04/2020 by wames

A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques, by Rebekah Maksoud, Stanley du Preez, Natalie Eaton-Fitch, Kiran Thapaliya, Leighton Barnden, Hélène Cabanas, Donald Staines, Sonya Marshall-Gradisnik in PLoS One 2020 Apr 30;15(4) [doi:10.1371/journal.pone.0232475.

 

Review Abstract:

BACKGROUND:

Myalgic encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterised by a diverse range of debilitating symptoms including autonomic and cognitive dysfunction.

The pathomechanism remains elusive, however, neurological and cognitive aberrations are consistently described. This systematic review is the first to collect and appraise the literature related to the structural and functional neurological changes in ME/CFS patients as measured by neuroimaging techniques and to investigate how these changes may influence onset, symptom presentation and severity of the illness.

METHODS:

A systematic search of databases Pubmed, Embase, MEDLINE (via EBSCOhost) and Web of Science (via Clarivate Analytics) was performed for articles dating between December 1994 and August 2019. Included publications report on neurological differences in ME/CFS patients compared with healthy controls identified using neuroimaging techniques such as magnetic resonance imaging, positron emission tomography and electroencephalography. Article selection was further refined based on specific inclusion and exclusion criteria. A quality assessment of included publications was completed using the Joanna Briggs Institute checklist.

RESULTS:

A total of 55 studies were included in this review. All papers assessed neurological or cognitive differences in adult ME/CFS patients compared with healthy controls using neuroimaging techniques.

The outcomes from the articles include changes in gray and white matter volumes, cerebral blood flow, brain structure, sleep, EEG activity, functional connectivity and cognitive function. Secondary measures including symptom severity were also reported in most studies.

CONCLUSIONS:

The results suggest widespread disruption of the autonomic nervous system network including morphological changes, white matter abnormalities and aberrations in functional connectivity. However, these findings are not consistent across studies and the origins of these anomalies remain unknown. Future studies are required confirm the potential neurological contribution to the pathology of ME/CFS.

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A potential antigenic mimicry between viral & human proteins linking ME/CFS with autoimmunity: the case of HPV immunization

Posted on 05/02/2020 by wames

A potential antigenic mimicry between viral and human proteins linking Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) with autoimmunity: the case of HPV immunization, by Jody Phelan, Anna D Grabowska, Nuno Sepulveda in Autoimmunity Reviews Vol 19, no. 4, April 2020,

 

1. Introduction

ME/CFS is a complex disease of unknown aetiology, but there is an increasing evidence which suggests an autoimmune component after a viral infection [1]. In the quest of understanding disease pathogenesis, Gherardi et al provided a thorough review of the role of adjuvants in the development of ME/CFS after vaccination [2]. As highlighted by the authors, many cases of vaccination-induced macrophagic myofasciitis could be alternatively classified as patients with ME/CFS using the 1994 CDC criteria [3].

In addition, vaccination against the human papillomavirus (HPV) seems to have the capacity of triggering different autonomic dysfunctions including ME/CFS [4]. Under the concept of Autoimmunity/Inflammation Syndrome Induced by Adjuvants (ASIA) [5], Gherardi et al [2] suggested that ME/CFS after vaccination results from a chronic and systemic inflammation triggered by a persistence and diffusion of adjuvants in the body.

As a general principle, vaccination uses attenuated versions of natural infections in order to generate immunological memory against a specific harmful microorganism. However, vaccination as well as a natural infection has also the potential to trigger an autoimmune response via molecular mimicry, as recently discovered for Pandemrix (a vaccine against H1N1 influenza A virus) and type 1 narcolepsy [6]. Another important example of molecular mimicry with potential devastating adverse events for vaccinated individuals has been discussed for the L1 proteins included in the bivalent Cervarix and the quadrivalent Gardasil [7,8], two vaccines against HPV discussed in Gherardi at el [2].

Antigen mimicry has also been hypothesized as the cause of a case suffering from pancreatitis after HPV immunization [9]. We revisited this topic in the context of ME/CFS by performing a stringent bioinformatic analysis of these vaccine proteins.

3. Discussion

In summary, our bioinformatic analysis identified a potential antigenic mimicry between HPV L1 and different human proteins. Two of our candidate epitopes are included in a long list pentapeptides and hexapeptides from HPV L1 proteins already identified in  previous studies [7–9]. The first one is the pentapeptide KFLLQAG from HPV16_L1, which has a high sequence homology with ANKDR16 human protein [7]. The second one is the hexapeptide ASSSRLL found in HPV6_L1 and HPV11_L1 proteins [9], which has already been validated experimentally as a strong inducer of virus-specific CD4+ T-cell responses [14]. The remaining epitopes identified here are novel and possibly so because of sequence variations in the L1 proteins used in this and previous studies.

From a standpoint of human genetics, HPV-vaccinated individuals who are carriers of either HLA-DRB1*01:01, HLA-DRB1*07:01, or HLA-DRB5*01:01 alleles might be at a higher risk of ME/CFS due to the suggested molecular mimicry. This genetic specificity is in line with several disparate associations between ME/CFS and different HLA genes reported in the literature [15,16]. However, given the numerous infection triggers of the disease [17], we foresee a problem of irreproducibility in future studies investigating these genetic associations. To overcome this problem, we suggest that researchers should make the effort of routinely collecting data and reporting on infection triggers of the disease in their study participants.

… In conclusion, the suggested molecular mimicry as a trigger of ME/CFS in HPV-vaccinated individuals is another piece of evidence supporting an autoimmune origin of the disease [1]. A fundamental question should be then addressed: what is the difference between ME/CFS and known autoimmune diseases? In this regard, Tregs might hold the answer to this question since these cells are thought to be key players in supressing deleterious autoreactive immune responses [27].

In addition, several studies reported an increased percentage of these cells in patients with ME/CFS when compared to healthy controls or autoimmune patients [28–30]. The overlooked role of these cells in ME/CFS will be discussed elsewhere [34].

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Report: Energy impairment and disability inclusion: towards an advocacy movement for energy limiting chronic illness

Posted on 05/01/2020 by wames

Energy impairment and disability inclusion: towards an advocacy movement for energy limiting chronic illness, by Catherine Hale, Stef Benstead, Jenny Lyus, Evan Odell and Anna Ruddock. Centre for Welfare reform: April 2020

 

DRILL Blog post: Energy impairment and disability inclusion – report by the Chronic Illness Inclusion Project

If you ask someone living with a debilitating chronic illness if they consider themselves to be disabled, you often get a “yes but, no but” kind of reply.

If you dig deeper, you may find their ambivalence is not so much because they see disability in negative terms. It’s often because they don’t feel entitled to the status of a disabled person.

People with invisible chronic illness typically experience hostility when positioning themselves as disabled – claiming disability benefits or using accessible toilets, for example. Whether from friends, acquaintances or impersonal bureaucracies, the response ranges from subtle expressions of disbelief to overt accusation of faking or attention seeking.

As someone living with chronic illness it took me almost two decades to shake off the pervasive sense of “feeling like a fraud” if I identified as disabled. The research conducted among my peers with the Chronic Illness Inclusion Project (CIIP) has opened my eyes to how widespread this phenomenon is.

The CIIP is part of the DRILL programme, hosted by the Centre for Welfare Reform. Our aim was to reach out into the digital world of our own chronic illness communities, and bring those voices and experiences into spaces where they are not normally heard.

Our report Energy impairment and disability inclusion suggests that this hostility towards invisible chronic illness is linked to an apparent gap in the language of disability and impairment for describing our bodily experiences. Organisations of and for disabled people rarely refer to ‘chronic illness’ in the way we do. And government systems of disability assessment don’t have tick boxes for our recording our experience.

The CIIP combined in-depth focus group research with a survey gathering over 2,000 responses. Across a wide range of reported diagnoses and disease groups, respondents reported that pathological fatigue, or energy limitation, was the most restricting feature of their condition, closely followed by pain.    Read more

CIIP Blog post: Bridging the chronic illness community and the disability rights movement

The CIIP conducted extensive research among the online chronic illness community in 2018. We pioneered an internet-based focus group format that allowed people to participant in in-depth discussions over an eight-week period from their home. And we ran a survey attracting over 2,000 responses.

Our findings include:

  • The experience of energy impairment unites people with many different diseases and health conditions.
  • People with energy limiting chronic illness (ELCI) are a hidden group of disabled people. We lack an identity and a voice as a defined group outside of our social media communities.
  • The experience of energy impairment is ignored by most disability assessment systems in the UK. And the adjustments and accommodations need by people with ELCI are not commonly included in disability equality initiatives.
  • Like all disabled people, we experience unnecessary exclusion, restriction and disadvantage on top of our symptoms. We call this “ableism”.
  • The ableism we experience centres on hostile attitudes, especially attitudes of denial and disbelief towards our disability.
  • Disability denial and disbelief prevent many people with ELCI from identifying, and being identified, as disabled people. This forms a major barrier to claiming our rights to equality and inclusion in society.

 

DNS blog: People with chronic illness face hostility and isolation’, says pioneering report, by John Pring, 30 April 2020

People with chronic illness face hostility and isolation because of society’s failure to understand how their impairment affects their lives, according to the results of a ground-breaking piece of user-led research.

The research concluded that the most “fundamental oppression” experienced by people with conditions such as ME, multiple sclerosis, fibromyalgia and Ehlers-Danlos syndrome was the “negative attitudes” they faced.

More than 80 per cent of the more than 2,000 people with chronic illness who took part in a survey for the research believed there was a denial and disbelief about the fatigue they experienced.

The Energy Impairment and Disability Inclusion report (PDF) found that those who challenged this oppression by identifying as disabled people found the experience “liberating”.

The main sources of oppressive attitudes were interactions with Department for Work and Pensions staff – particularly in relation to personal independence payment – and healthcare professionals.

Understanding that the “disbelief and invalidation” they face is a disabling barrier is crucial to developing a social model of chronic illness, the report suggests.

Read more

 

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Pediatric-onset Postural Orthostatic Tachycardia Syndrome in a single Tertiary Care Center

Posted on 05/01/2020 by wames

Pediatric-onset Postural Orthostatic Tachycardia Syndrome in a single Tertiary Care Center, by Anthony Staples, Nicolas R Thompson and Manikum Moodley in J Child Neurol. Vol 35, Issue 8, 2020 [doi: 10.1177/0883073820916260]

 

Research abstract:

AIM:
We characterize the pediatric postural orthostatic tachycardia syndrome (POTS) population seen at a single tertiary care referral center.

METHOD:
Retrospective chart review of all pediatric POTS patients seen in our center between 2015 and 2017. Pediatric POTS was defined as chronic, at least 3 months, symptoms of orthostatic intolerance associated with excessive orthostatic tachycardia as determined by tilt table testing with orthostatic heart rate increment of ≥40 bpm within 5 minutes of head-up tilt or absolute orthostatic heart rate ≥130 bpm for patients 13 years old and younger and ≥120 bpm for those 14 years and older.

We looked at demographics, presenting symptoms, comorbidities, examination findings, investigation findings, treatment, and patient reported outcomes. Outcome measures were separated by patient report and group comparisons were made using 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables.

RESULTS:
One hundred thirty-four patients with pediatric onset POTS were identified. The mean age was 15 years. Seventy-nine percent of patients were female and 90% were white. The most common presenting symptoms included dizziness/lightheadedness (88%), syncope (54%), and palpitations (40%). Many patients had significant comorbidities attributable to numerous bodily systems, most commonly headache syndromes (migraine 43%, nonspecific headache 22%, chronic daily headache 14%, and new daily persistent headache 5%) and chronic fatigue (60%). Low vitamin D and insufficient iron stores were commonly seen.

The majority of patients improved or had resolution of symptoms following treatment (70%). When separated by outcome, statistically significant differences were found for glucose (patients whose symptoms resolved had higher median glucose), palpitations (patients whose symptoms resolved were less likely to have palpitations), constipation (patients whose symptoms were stable/worsened were more likely to have constipation), and unexplained pain (patients whose symptoms were stable/worsened were more likely to have unexplained pain).

CONCLUSIONS:
Pediatric POTS is a chronic condition with a fairly good prognosis following appropriate treatment. It is associated with numerous comorbidities that necessitate multidisciplinary expert care.

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Energy management education & occupation-related outcomes in adults with chronic diseases: a scoping review

Posted on 05/01/2020 by wames

Energy management education and occupation-related outcomes in adults with chronic diseases: a scoping review, by Janine F Farragher , Sarbjit V Jassal, Sara McEwen, Helene J Polatajko in Brit J Occ Ther, April 10, 2020  [doi.org/10.1177/0308022620904327]

 

Article abstract:

Introduction:
Fatigue is a pervasive symptom of chronic disease that often interferes with occupational performance. Our objective was to describe what is known about energy management education and occupation-related outcomes in adults with chronic diseases.

Methods:
Seven electronic databases were searched for relevant literature published before August 2019. Eligible articles were full-text, available in English, and studied energy management education in adults with a chronic disease. The first author assessed article eligibility with validation from a second reviewer, extracted characteristics of included studies, and described them using descriptive statistics. A narrative synthesis of findings was conducted for each chronic disease population.

Results:
Forty-four studies addressed eight different chronic disease populations. The most common program delivery format was face-to-face in a group setting (42%), 39% of programs were informed by a learning theory, and their median cumulative length was 8 hours. Positive outcomes were associated with a specific, group-based energy management program in people with multiple sclerosis. The evidence on other energy management programs and in other chronic disease populations was more limited and inconclusive.

Conclusions:
Further research is needed to understand the impact of energy management education in chronic disease populations beyond multiple sclerosis, and its impact on occupational performance.

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Extract from Discussion:

Our study is the first to comprehensively identify and describe the literature on EME and occupational performance or related outcomes in adults with chronic diseases. EME has been studied in eight different chronic disease populations, including MS, cancer, CFS, cardiac disease, arthritis, acquired brain injury, fibromyalgia and post-polio syndrome.

The literature was most extensive on the six-session, group-based “Managing Fatigue” program (Packer et al., 1995) in MS, where studies including RCTs suggested positive impacts on outcomes related to occupational performance, such as fatigue impact and self-efficacy…

However, the evidence on EME for other programs and chronic disease populations was found to be more limited, and often described mixed or inconclusive findings. There were also few studies that directly investigated the effects of EME on occupational performance.

The lack of robust research on EME outside of MS is surprising, given the prevalence of fatigue in many chronic diseases populations and the need for evidence-based interventions to improve fatigue management. In some populations (for example arthritis, post-polio, cardiac disease), although preliminary findings appeared to be promising, a lack of RCTs limits the conclusions that can be drawn about the efficacy of the approach.

In other populations (for example cancer and CFS), although large RCTs have been conducted, they had potential methodological limitations that might minimize their validity. For example, in cancer, an RCT that reported EME had limited effects on fatigue and physical function (Barsevick et al., 2004) used a very brief EME program, which might have provided insufficient education to achieve positive outcomes. In CFS, a large RCT showed no effect of an extensive, individually delivered EME program on occupational performance, fatigue, physical performance, or mental health (White et al., 2011), but the validity of this trial and its conclusions have been questioned due to several methodological concerns since its publication (Jason, 2017; Wilshire et al., 2017), including concerns with the activity pacing intervention (Jason, 2017).

We also found no studies (preliminary or other) on EME in other chronic disease populations known to have a high burden of fatigue, such as chronic kidney disease (Murtagh et al., 2007) and chronic obstructive pulmonary disease (Baltzan et al., 2011).

Collectively, this review highlights the need for more well-designed primary studies about EME in adults with chronic diseases, to support occupational therapists seeking to engage in evidence-based practice in this area

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Underfunding of biomedical research into Myalgic Encephalomyelitis is unjustified, say MEPs

Posted on 05/01/2020 by wames

PETI European News Press Release: Underfunding of biomedical research into Myalgic Encephalomyelitis is unjustified, say MEPs 30 April 2020

 

  • An estimate of 2 million Europeans affected by the disease
  • EU research remains fragmented and lacks coordination
  • ME/CFS is still poorly understood and consequently, underdiagnosed

Petitions MEPs raise concerns over underfunding of EU research into Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS), in a resolution adopted on Thursday.

In a draft resolution adopted today with 30 votes in favour and none against, Petitions MEPs call for additional EU funding to advance research on diagnostic tests and treatment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS).

This comes after Parliament has tabled several questions to the European Commission on the topic and received a number of petitions raising concerns over the absence of treatment and insufficient funding for research related to the disease that affects an estimate of 2 million people within the EU.

Support for biomedical research

The Petitions Committee welcomes the Commission’s commitments under Horizon 2020 (the EU Framework Programme for Research and Innovation for 2014-2020), however it believes that current underfunding of biomedical research into ME/CFS is “unjustified”, considering the large number of patients and high socio-economic impact of the disease.

The report underlines the urgent need to address the human and socio-economic costs of individuals living and working with long-term disabling and chronic conditions and calls on the Commission to allocate additional funding and prioritise projects focused on biomedical research.

Promoting cooperation

MEPs welcome the Commission’s support for the European Cooperation in Science and Technology organisation (COST), which recently created the European network of ME/CFS research groups (Euromene). While the network of researchers has been working to establish a common EU approach to address gaps in knowledge related to the disease, MEPsbelieve that research efforts remain fragmented and coordination across the EU is missing.

The report calls for more European and international cooperation on research into ME/CFS, in order to speed up the development of objective diagnostics standards and effective treatment. The Commission should also look into the feasibility of an EU fund for
prevention and treatment of ME/CFS, say MEPs. The draft resolution recalls that biomedical diagnostic tests for ME/CFS do not exist to this day, nor are there any U/EMA-approved treatments for the disease.

Raising awareness

Due to insufficient knowledge among healthcare providers and absence of appropriate testing, ME/CFS is still poorly understood and as a result, underdiagnosed. Poor  knowledge also can lead to stigmatisation and psychological distress, remind MEPs.

The resolution emphasises the lack of recognition and awareness on this type of diseases and calls on the Commission and member states to launch information and awareness campaigns among health professionals and the public.

Horizon Europe and the next MFF

Finally, in the context of the ongoing negotiations on the next EU Multiannual Financial Framework (2021-2027), MEPs urge the Council to swiftly accept Parliament’s request for a bigger budget for Horizon Europe (which will succeed Horizon 2020), so that future research on ME/CFS can begin on time.

Background information

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disabling and complex chronic disease of unknown origin, whose symptoms, severity and progression are extremely variable. The economic burden of the disease across Europe was estimated to amount to EUR 40 billion each year. According to the PETI resolution, an estimate of 2 million people in the EU have the disease, with women being the most affected among adults.

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Solving the ME/CFS criteria & name conundrum: the aftermath of IOM

Posted on 04/30/2020 by wames

Solving the ME/CFS criteria and name conundrum: The aftermath of IOM, by Leonard A Jason, Madeline Johnson in Fatigue: Biomedicine, Health & Behavior, 28 Apr 2020

 

Article abstract:

In 2015, the Institute of Medicine (IOM) proposed a new name and set of clinical criteria for what had previously been referred to as Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS). This committee recommended the adoption of the term systemic exertion intolerance disease (SEID) and clinical criteria that required specific symptoms such as post-exertional malaise and unrefreshing sleep.

This article reviews efforts to evaluate the revised criteria as well as reactions to the new criteria and name. Since these recommendations have been made, the proposed name change has not been widely adopted by the scientific or patient community.

Even though the IOM’s proposed criteria were intended to be a clinical rather than a research case definition, over the past few years, an increasing number of studies have employed these criteria for research purposes. One unwitting consequence of the IOM criteria, which excludes few other illnesses, is the broadening of the number of individuals who are diagnosed and included in research studies.

There is still a need to implement the IOM’s recommendation to form a multidisciplinary committee to review research and policy changes following the release of the new criteria.

We conclude by presenting a possible roadmap for overcoming barriers in order to make progress on developing a consensus for a name and criteria.

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Patient experiences & the psychosocial benefits of group aquatic exercise to reduce symptoms of ME/CFS: a pilot study

Posted on 04/28/2020 by wames

Patient experiences and the psychosocial benefits of group aquatic exercise to reduce symptoms of ME/CFS: a pilot study, by  Suzanne Broadbent, Sonja Coetzee Rosalind Beavers &  Louise Horstmanshof in Fatigue: Biomedicine, Health & Behavior, [DOI: 10.1080/21641846.2020.1751455]  Published online: 11 Apr 2020

 

Research abstract:

Background:

The aim of the study was to explore the experiences of participants in a short aquatic exercise programme for individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, and to gain insight into the perceived psychosocial benefits.

Methods:

The exercise programme was of five-weeks duration, with two self-paced aquatic sessions per week. Eleven female participants (mean age 54.8 ± 12.4 yr) reported the onset and changes (24–48 h) in post-exercise fatigue, pain and other symptoms after each session, and completed a post-intervention interview comprising nine open-ended questions, with additional discussions. The reported symptoms and interview responses were entered into a spreadsheet, grouped and coded to identify the themes and subthemes.

Results:

The main themes were ‘symptoms’, ‘benefits’, ‘engagement and compliance’, and ‘limitations’. The analysis found that group aquatic exercises reduced social isolation through shared experiences and enhanced support; were beneficial and enjoyable without exacerbating symptoms; were preferable to other modes of exercise; and were seen as a long-term exercise option. Participants reported a reduction in pain, fatigue and anxiety after the intervention.

Conclusions:

Psychosocial benefits suggest that self-paced group aquatic exercise is a safe, enjoyable and effective mode of exercise rehabilitation for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

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