Evaluating the effects of amantadin, modafinil and acetyl- l -carnitine on fatigue in multiple sclerosis – result of a pilot randomized, blind study

• Published in: Clinical neurology and neurosurgery Vol. 115; no. S1; pp. S86 - S89
• Main Authors: Ledinek, Alenka Horvat, Sajko, Mojca Cizek, Rot, Uros
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-12-2013; Elsevier Limited
• Subjects: Acetyl-L-carnitine; Acetylcarnitine - therapeutic use; Adult; Amantadine; Amantadine - therapeutic use; Antidepressants; Benzhydryl Compounds - therapeutic use; Confidence intervals; Drug Combinations; Drug dosages; Drug therapy; Fatigue; Fatigue - drug therapy; Female; Humans; Male; Middle Aged; Modafinil; Multiple sclerosis; Multiple Sclerosis - drug therapy; Neurology; Neurosurgery; Pilot Projects; Quality of life; Treatment Outcome; Variance analysis; Fatigue; Multiple sclerosis; Amantadine; Modafinil; Acetyl- l-carnitine; Acetyl-l-carnitine
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2013.09.029

Abstract Objective Fatigue affects more than 60% of multiple sclerosis (MS) patients and is one of the most troublesome symptoms of the disease. Current treatment options for MS fatigue include amantadine, modafinil and acetyl- l -carnitine (ALCAR). The aim of our study was to compare efficacy of amantadine, modafinil and ALCAR with placebo in patients with MS. Methods Patients with MS and a disability level ≤5.5 on the Kurtzke Expanded Disability Status Scale (EDSS) and fatigue were included in the study. Patients were assigned to a one month treatment with either amantadine 200 mg, ALCAR 2 g, modafinil 200 mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS). Results Sixty patients were included in the study (39 females). The mean age of patients was 38 ± 6.7 years and the mean disease duration was 6.6 ± 1.2 years. Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference = 17.3, p = 0.001). There was also a trend of a lower MFIS score in ALCAR group in comparison to placebo (mean difference = 12.4, p = 0.05, with Keppel-corrected alpha of 0.046). The quality of life measured as SF 36 – PCS and SF 36 – MCS proved to be significantly influenced by treatment. Conclusion One month treatment with amantadine improved fatigue in patients with relapsing-remitting MS as evaluated by MFIS. No or only a trend of improvement was seen in patients treated with modafinil or ALCAR, respectively.