Fludrocortisone, a drug prescribed
to treat low blood pressure, has little or no effect on symptoms of chronic
fatigue syndrome in adults when it is used as the only form of treatment,
according to a joint study by the Johns Hopkins Children's Center and the
National Institute of Allergy and Infectious Diseases (NIAID). (JAMA 1-01)
http://www.newswise.com/articles/2001/1/FATIGUE.JHM.html
Johns Hopkins Medical
Institutions
Fludrocortisone,
a drug prescribed to treat low blood pressure, has little or no effect
on symptoms of chronic fatigue syndrome in adults when it is used as the
only form of treatment, according to a joint study by the Johns Hopkins
Children's Center and the National Institute of Allergy and Infectious
Diseases (NIAID). A report of the study appears in this week's Journal
of the American Medical Association.
In a preliminary
study published in 1995, Peter Rowe, M.D., leader of the Johns Hopkins
team, reported that many patients diagnosed with chronic fatigue syndrome
(CFS) developed lightheadedness, fatigue, and sometimes fainted when they
stood for prolonged periods of time. When tilted head-up on a special diagnostic
table, most patients developed a sudden drop in blood pressure known as
neurally mediated hypotension (NMH). Some study participants reported substantial
relief in their lightheadedness and CFS symptoms when treated with a combination
of an increase in dietary sodium chloride (table salt), fludrocortisone,
and other medications. Fludrocortisone helps to maintain a normal blood
pressure by reducing the loss of sodium from the bloodstream.
The researchers conducted
the current, more rigorous study to determine whether isolating one component
of the treatment -- fludrocortisone -- would be equally effective in treating
symptoms. Over nine weeks, 50 adults with both CFS and NMH received fludrocortisone,
and 50 received a placebo. Neither group took supplemental sodium. During
the study, investigators and study participants were unaware of who received
the fludrocortisone or the placebo. At the end of the treatment period,
14 percent of those treated with fludrocortisone described a notable improvement
in overall well-being, compared with 10 percent in the placebo group, a
difference that was not deemed statistically significant by researchers.
Since this current
study began in 1996, other studies have identified four drugs effective
in treating some people with recurrent fainting due to NMH.
"One of these medications
may prove more effective than fludrocortisone in treating NMH among those
with CFS," says Rowe. "Over 60 percent of the patients we screened for
this study had abnormal heart rate and blood pressure responses during
tilt testing, and most had worse symptoms brought on early in the test.
Their responses to upright posture suggest a need to better define the
optimal way to treat NMH in people with CFS. In the patients we studied,
clearly, fludrocortisone alone was insufficient."
CFS affects approximately
one of every 250 Americans. Although profound fatigue is a defining feature
of the syndrome, other important problems include difficulty with memory
and concentration, sleep disturbance, muscle aches, and headaches. The
causes of CFS are not known. Treatment is aimed at relieving individual
symptoms. No medication has been found effective in treating the disorder
as a whole.
The study was funded
by grants from the National Institute of Allergy and Infectious Disease,
the Johns Hopkins Outpatient General Clinical Research Center, and the
Chronic Fatigue and Immune Dysfunction Syndrome Association of America,
Inc.
Media Contacts:
4-Jan-01
David Bricker or
Staci Vernick
Johns Hopkins Children's
Center
410-223-1747