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Potential Drugs for Improving Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is the current name for a disorder Characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. Specific symptoms reported by CFS patients are fatigue, difficult concentration, headache, sore throat, tender lymph node, muscle ache, joint ache, feverishness, and allergies.

There are several hypotheses about its etiology, including postinfectious, immunological, neuroendocrine, neurological, and psychological ones. A CNS dysfunction brought about by abnormal cytokine release in response to antigenic challenge has been described.¹ Substantial evidences show a pivotal role for proinflammatory Cytokines (e.g., interleukin1, interleukin6, and tumor necrosis factor-) in induction of CNS mediated responses such as fever, somnolence, and sickness behavior in acute infections. A significant elevation in serum levels of interleukin-1, and tumor necrosis factor- in the patient with chronic fatigue syndrome have been reported.²

Recently, biological agents that bind and neutralize the tumor necrosis factor have become available:

1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1, is assessed to be effective in psoriasis.³

2) Infliximab, a chimeric mouse-human monoclonal antibody to the tumor necrosis factor, has shown successful trials for treating inflammatory bowel disease.

3) Adalimumab, a fully human antibody to the tumor necrosis factor, is used in cutaneous sarcoidosis.

4) Thalidomide has immunomodulatory and anti-inflammatory effects including inhibition of synthesis of the tumor necrosis factor –. It is effective for treating Behçets syndrome.⁴

We suggest that these drugs, which are approved by FDA for some of the aforementioned diseases, can be useful in treating patients with chronic fatigue syndrome. Even modest improvement in symptoms can make an important difference in the patient’s degree of self-sufficiency and ability to appreciate life’s pleasures.⁵ Surely, clinical trials should be done to assess the efficacy versus side effects of these drugs on affected patients.

REFERENCES

1. Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic fatigue syndrome: a review. N Z Med J 2005; 118:U1780
2. Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls. Psychiatry Res 2005; 134:101–104[CrossRef][Medline]
3. Bos JD, de Korte J: Effects of etanercept on quality of life, fatigue, and depression in psoriasis. Lancet 2006; 367:6–7[CrossRef][Medline]
4. Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of recurrent perforating intestinal ulcers with thalidomide in Behcet’s disease. Ann Pharmacother 2004; 38:808–811.[Abstract/Free Full Text]
5. Straus SE: Chronic fatigue syndrome, in Harrison’s Textbook of Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545-2547

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