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Effect of Galantamine Hydrobromide in Chronic Fatigue Syndrome
A Randomized Controlled Trial
C. V. Russell Blacker, FRCPsych, MD;
David T. Greenwood, PhD;
Keith A. Wesnes, PhD;
Rosamund Wilson, PhD;
Carol Woodward, BSc;
Ian Howe, MD;
Tauhid Ali, MSc
JAMA. 2004;292:1195-1204.
Context There is no established pharmacological treatment for the core symptoms of chronic fatigue syndrome (CFS). Galantamine hydrobromide, an acetyl cholesterone inhibitor, has pharmacological properties that might benefit patients with CFS.
Objective To compare the efficacy and tolerability of galantamine hydrobromide in patients with CFS.
Design, Setting, and Patients Randomized, double-blind trial conducted June 1997 through July 1999 at 35 outpatient centers in the United Kingdom (n = 17), United States (n = 14), the Netherlands (n = 2), Sweden (n = 1), and Belgium (n = 1) involving 434 patients with a clinical diagnosis of CFS (modified US Centers for Disease Control and Prevention criteria).
Interventions A total of 89 patients were randomly assigned to receive 2.5 mg of galantamine hydrobromide; 86 patients, 5.0 mg; 91 patients, 7.5 mg; and 86 patients, 10 mg (these patients received medicine in the tablet form 3 times per day); a total of 82 patients received matching placebo tablets 3 times per day.
Main Outcome Measures The primary efficacy variable was the global change on the Clinician Global Impression Scale after 4, 8, 12, and 16 weeks of treatment. Secondary outcomes were changes in core symptoms of CFS on the Chalder Fatigue Rating Scale, the Fibromyalgia Impact Questionnaire, and the Pittsburgh Sleep Quality Index; changes in quality of life on the Nottingham Health Profile; and assessment of plasma-free cortisol levels and cognitive performance on a computer-based battery of tests.
Results After 16 weeks, there were no statistically significant differences between any of the galantamine or placebo groups in clinical condition on the Clinician Global Impression Scale, or for any of the secondary end points. Exploratory regression analysis failed to detect any consistent prognostic factor that might have influenced the primary or any secondary outcome measures.
Conclusion This trial did not demonstrate any benefit of galantamine over placebo in the treatment of patients with CFS.
Author Affiliations: Department of Health and Social Sciences, University of Exeter, Exeter, England (Dr Blacker); Marix Drug Development Ltd, Cardiff, England (Dr Greenwood); PPD Development, Cambridge, England (Ms Woodward); Cognitive Drug Research Ltd, Goring-on-Thames, England (Dr Wesnes); Spica Consultants Ltd, East Grafton, England (Dr Wilson); Shire Pharmaceutical Development Ltd, Hampshire, England (Dr Howe); and Bioenvision Ltd, Edinburgh, Scotland (Mr Ali).
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