Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Trial Fails to Confirm Earlier Observations of Rituximab's Effectiveness
Authors: Peter C. Rowe
Journal: Annals of Internal Medicine (2019)

Editorials7 May 2019Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Trial Fails to Confirm Earlier Observations of Rituximab's EffectivenessPeter C. Rowe, MDPeter C. Rowe, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (P.C.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0643 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, complex, multisystem condition that affects at least 1 million persons in the United States and millions of others worldwide (1). It is defined by substantial impairment in preillness levels of activity and function, along with prominent symptoms of excessive fatigue, unrefreshing sleep, postexertional malaise (a general symptom provocation after a person's usual physical or cognitive exertion is exceeded), difficulty with cognitive tasks, and orthostatic intolerance (1).Many treatments are available to address individual ME/CFS symptoms, including interventions effective for postural tachycardia syndrome, syncope, fibromyalgia, chronic pain, and headaches. Several small randomized trials ...References1. Unger ER, Lin JS, Brimmer DJ, Lapp CW, Komaroff AL, Nath A, et al. CDC grand rounds: chronic fatigue syndrome—advancing research and clinical education. MMWR Morb Mortal Wkly Rep. 2016;65:1434-8. [PMID: 28033311] doi:10.15585/mmwr.mm655051a4 CrossrefMedlineGoogle Scholar2. Smith ME, Haney E, McDonagh M, Pappas M, Daeges M, Wasson N, et al. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:841-50. [PMID: 26075755]. doi:10.7326/M15-0114 LinkGoogle Scholar3. Wilshire CE, Kindlon T, Courtney R, Matthees A, Tuller D, Geraghty K, et al. Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC Psychol. 2018;6:6. [PMID: 29562932] doi:10.1186/s40359-018-0218-3 CrossrefMedlineGoogle Scholar4. Fluge Ø, Mella O. Clinical impact of B-cell depletion with the anti-CD20 antibody rituximab in chronic fatigue syndrome: a preliminary case series. BMC Neurol. 2009;9:28. [PMID: 19566965] doi:10.1186/1471-2377-9-28 CrossrefMedlineGoogle Scholar5. Fluge Ø, Bruland O, Risa K, Storstein A, Kristoffersen EK, Sapkota D, et al. Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome. A double-blind and placebo-controlled study. PLoS One. 2011;6:e26358. [PMID: 22039471] doi:10.1371/journal.pone.0026358 CrossrefMedlineGoogle Scholar6. Fluge Ø, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, et al. B-lymphocyte depletion in patients with myalgic encephalomyelitis/chronic fatigue syndrome. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2019;170:585-93. doi:10.7326/M18-1451 LinkGoogle Scholar7. Sotzny F, Blanco J, Capelli E, Castro-Marrero J, Steiner S, Murovska M; European Network on ME/CFS (EUROMENE). Myalgic encephalomyelitis/chronic fatigue syndrome—evidence for an autoimmune disease. Autoimmun Rev. 2018;17:601-9. [PMID: 29635081] doi:10.1016/j.autrev.2018.01.009 CrossrefMedlineGoogle Scholar8. Rowe KS. Double-blind randomized controlled trial to assess the efficacy of intravenous gammaglobulin for the management of chronic fatigue syndrome in adolescents. J Psychiatr Res. 1997;31:133-47. [PMID: 9201655] CrossrefMedlineGoogle Scholar9. Prescott HC, Calfee CS, Thompson BT, Angus DC, Liu VX. Toward smarter lumping and smarter splitting: rethinking strategies for sepsis and acute respiratory distress syndrome clinical trial design. Am J Respir Crit Care Med. 2016;194:147-55. [PMID: 27244481] doi:10.1164/rccm.201512-2544CP CrossrefMedlineGoogle Scholar10. Demitrack MA. Clinical methodology and its implications for the study of therapeutic interventions for chronic fatigue syndrome: a commentary. Pharmacogenomics. 2006;7:521-8. [PMID: 16610962] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins University School of Medicine, Baltimore, Maryland (P.C.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0643.Corresponding Author: Peter C. Rowe, MD, Division of General Pediatrics and Adolescent Medicine, 200 North Wolfe Street, Room 2077, Baltimore, MD 21287; e-mail, [email protected]edu.This article was published at Annals.org on 2 April 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoB-Lymphocyte Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Øystein Fluge , Ingrid G. Rekeland , Katarina Lien , Hanne Thürmer , Petter C. Borchgrevink , Christoph Schäfer , Kari Sørland , Jörg Aßmus , Irini Ktoridou-Valen , Ingrid Herder , Merethe E. Gotaas , Øivind Kvammen , Katarzyna A. Baranowska , Louis M.L.J. Bohnen , Sissel S. Martinsen , Ann E. Lonar , Ann-Elise H. Solvang , Arne E.S. Gya , Ove Bruland , Kristin Risa , Kine Alme , Olav Dahl , and Olav Mella Metrics Cited byComplex syndromes of chronic pain, fatigue and cognitive impairment linked to autoimmune dysautonomia and small fiber neuropathy 7 May 2019Volume 170, Issue 9Page: 656-657KeywordsAutoantibodiesChemotherapyClinical trial reportingClinical trialsDisclosureExercise therapyFatigueSleepSyncopeTachycardia ePublished: 2 April 2019 Issue Published: 7 May 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...