Intravenous Immunoglobulin is Ineffective in the Treatment of Patients with Chronic Fatigue Syndrome
Section snippets
Patients
Ninety-nine patients with CFS were enrolled in the collaborating Australian institutions: 82 at the Prince Henry Hospital, Sydney, and 17 at the Woden Valley Hospital, Canberra. A diagnosis of CFS required that a medical and psychiatric history, a thorough physical examination, and laboratory assessment did not establish another explanation for chronic fatigue to meet diagnostic criteria for CFS, which were available at the time of enrollment for this study.18, 19The standardized investigation
Evaluation at Entry
The randomization code allocated 73 patients to receive immunoglobulin (22 received 0.5 g/kg, 28 1 g/kg, and 23 2 g/kg dosage) and 26 to receive placebo. The demographic, immunologic, and clinical data obtained on entry are shown in Table 1. There were no statistically significant differences between the treatment groups for these variables. Apparent between-group differences in the proportions of patients with abnormal DTH skin responses, the number of CD4 positive lymphocytes, and the POMS
Discussion
The results of this double-blind, placebo-controlled trial fail to demonstrate any significant benefit across several dosages of intravenous immunoglobulin in the treatment of CFS. Although some improvement in clinical symptoms (including functional capacity, subjective energy, QAL scores) were demonstrated, these improvements were not linked to a particular dosage of immunoglobulin. In fact, improvements occurred irrespective of whether patients received immunoglobulin or placebo infusions.
Acknowledgements
This study was supported by Commonwealth Serum Laboratories and the Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis Society of New South Wales.
References (26)
- et al.
Science and speculation: the treatment of chronic fatigue syndrome
Am J Med.
(1994) - et al.
A double-blind placebo-controlled trial of intravenous immunoglobulin therapy in patients with the chronic fatigue syndrome
Am J Med.
(1990) - et al.
A controlled trial of intravenous immunoglobulin G in chronic fatigue syndrome
Am J Med.
(1990) - et al.
The postviral fatigue syndrome—analysis of the findings in 50 cases
J Infect.
(1985) - et al.
Pathophysiology of myalgic encephalomyelitis
Lancet.
(1987) - et al.
Chronic fatigue syndrome: Clinical condition associated with immune activation
Lancet.
(1991) - et al.
Immunologic and psychologic therapy for patients with chronic fatigue syndrome: A double-blind placebo-controlled trial
Am J Med.
(1993) - et al.
The chronic fatigue syndrome: A comprehensive approach to its definition and study
Ann Intern Med.
(1994) - et al.
Can the chronic fatigue syndrome be defined by distinct clinical features?
Psychol Med.
(1995) - et al.
The economic impact of chronic fatigue syndrome
Med J Aust.
(1992)
The chronic mononucleosis syndrome
J Infect Dis.
The existence of a fatigue syndrome after glandular fever
Psychol Med.
The validity and reliability of the fatigue syndrome which follows glandular fever
Psychol Med.
Cited by (75)
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease
2018, Autoimmunity ReviewsChronic Fatigue Syndrome
2017, Principles and Practice of Pediatric Infectious DiseasesUpdate on the use of immunoglobulin in human disease: A review of evidence
2017, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Chronic fatigue syndrome is a clinically defined disorder that has often been associated with mild immune dysfunction according to specific criteria.551 There have been numerous anecdotal reports of IVIG use having subjective benefits; however, IVIG is not effective in the treatment of typical chronic fatigue syndrome, as demonstrated in a double-blind, placebo-controlled trial.552 Chronic fatigue may be associated with specific viral infections, such as parvovirus (erythrovirus) B19.
Chronic Fatigue Syndrome
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious DiseasesFatigue in neurologic disorders
2013, Sleep Medicine ClinicsCitation Excerpt :Similarly, although growth hormone therapy was found not to improve quality of life indices, 23% of patients so treated returned to work after long absences.151 There have been contradictory results with trials of IVIG in the treatment of CFS, although most studies indicate no benefit.152–154 CBT has consistently been found effective in CFS.155,156