Abstract
BackgroundMultiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS).MethodsSystematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data.ResultsThe search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records.Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS.ConclusionFatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.
Highlights
Multiple sclerosis (MS) is a chronic inflammatory disease that results in progressive demyelination in the central nervous system
An additional 20 records were identified through the supplementary screen for economic studies with fatigue as a continuous measure
This study demonstrated that fatigue was a significant predictor of poorer than average physical quality of life (QoL) (PCS < 40) (OR = 11.00 [95% Confidence interval (CI): 2.94, 40.78]) and mental QoL (MCS < 40) (OR = 8.64 [95% CI: 2.39, 31.28]) [88]
Summary
Multiple sclerosis (MS) is a chronic inflammatory disease that results in progressive demyelination in the central nervous system. The clinical course of MS can be differentiated by disease history, progression of irreversible disability, and the presence or absence of acute disease relapses. 85% of pwMS are initially diagnosed with RRMS, which may eventually progress to SPMS with or without superimposed relapses [5]. Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS)
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