CBT alone, drug therapy alone, and combining the two reduced fatigue in patients with MS — but the combination showed the greatest benefit, experts say. ACTRIMS2023
SAN DIEGO — Cognitive behavioral therapy , the wakefulness-promoting drug modafinil , and a combination of both treatments all reduce fatigue in patients with multiple sclerosis — but the combination has an edge when it comes to overall perceived benefits, new research shows.
CBT, which teaches strategies to target maladaptive thoughts and beliefs, is one of the most promising behavioral strategies, the investigators note. It has been shown to be effective for multiple conditions including depression, posttraumatic stress disorder, insomnia, and pain. The new 12-week parallel-arm, analyst-blinded COMBO-MS trial included 336 participants . Most of the patients were White and most had relapsing remitting MS .
"But even though the combination therapy ended up having the highest absolute reduction, it ultimately was not statistically significant," she added. Sleep hygiene significantly moderated the treatment effect . As sleep hygiene worsens, the effect of modafinil monotherapy relative to CBT monotherapy appeared to diminish, and behavior therapy started to have more benefit relative to modafinil therapy, the investigators note.
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