Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial
RCT (n=141) reports amantadine, modafinil and methylphenidate were not superior to placebo in improving multiple sclerosis fatigue, based on the Modified Fatigue Impact Scale (MFIS) score; and caused more frequent adverse events.
Source:
The Lancet Neurology
SPS commentary:
The estimated mean values of MFIS total scores at baseline and at the maximal tolerated dose were as follows: 51.3 (95% CI 49.0–53.6) at baseline, 40.6 (38.2–43.1) with placebo, 41.3 (38.8–43.7) with amantadine, 39.0 (36.6–41·4) with modafinil, and 38.6 (36.2–41.0) with methylphenidate (p=0.20 for the overall medication effect).l). As compared with placebo (38 [31%] of 124 patients), higher proportions of participants reported adverse events while taking amantadine (49 [39%] of 127 patients), modafinil (50 [40%] of 125 patients), and methylphenidate (51 [40%] of 129 patients).
Authors of a related commentary state the results of this study do not support an indiscriminate use of amantadine, modafinil, or methylphenidate for the treatment of fatigue in multiple sclerosis.