title: Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.
abstract: BACKGROUND
  Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a debilitating multisystem condition affecting more than 1 million adults in the United States.
  
  
  OBJECTIVE
  To determine benefits and harms of treatments for adults with ME/CFS and identify future research needs.
  
  
  METHODS
  MEDLINE, PsycINFO, and Cochrane databases (January 1988 to September 2014); clinical trial registries; reference lists; and manufacturer information.
  
  
  METHODS
  English-language randomized trials of the effectiveness and adverse effects of ME/CFS treatments.
  
  
  METHODS
  Data on participants, study design, analysis, follow-up, and results were extracted and confirmed. Study quality was dual-rated by using prespecified criteria; discrepancies were resolved through consensus.
  
  
  RESULTS
  Among 35 treatment trials enrolling participants primarily meeting the 1994 Centers for Disease Control and Prevention and Oxford case definitions of CFS, the immune modulator rintatolimod improved some measures of exercise performance compared with placebo in 2 trials (low strength of evidence). Trials of galantamine, hydrocortisone, IgG, valganciclovir, isoprinosine, fluoxetine, and various complementary medicines were inconclusive (insufficient evidence). Counseling therapies and graded exercise therapy compared with no treatment, relaxation, or support improved fatigue, function, global improvement, and work impairment in some trials; counseling therapies also improved quality of life (low to moderate strength of evidence). Harms were rarely reported across studies (insufficient evidence).
  
  
  CONCLUSIONS
  Trials were heterogeneous and were limited by size, number, duration, applicability, and methodological quality.
  
  
  CONCLUSIONS
  Trials of rintatolimod, counseling therapies, and graded exercise therapy suggest benefit for some patients meeting case definitions for CFS, whereas evidence for other treatments and harms is insufficient. More definitive studies comparing participants meeting different case definitions, including ME, and providing subgroup analysis are needed to fill research gaps.
authors.forename: M E Beth
authors.initials: ME
authors.lastname: Smith
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Haney
authors.forename: Marian
authors.initials: M
authors.lastname: McDonagh
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.forename: Monica
authors.initials: M
authors.lastname: Daeges
authors.forename: Ngoc
authors.initials: N
authors.lastname: Wasson
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies; D003376:Counseling; D004679:Encephalomyelitis / Q000188:drug therapy / Q000628:therapy*; D005081:Exercise Therapy; D015673:Fatigue Syndrome, Chronic / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D063806:Myalgia / Q000188:drug therapy / Q000628:therapy*; D011070:Poly I-C / Q000627:therapeutic use; D011072:Poly U / Q000627:therapeutic use; D011788:Quality of Life
chemical_list: D000998:Antiviral Agents; D007155:Immunologic Factors; D011072:Poly U; C047490:poly(I).poly(c12,U); D011070:Poly I-C