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Comments on the CDC evidence review on ME/CFS In a previous blog post, we summarized the draft report of a systematic review on the management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The review was commissioned by the Centers for Disease Control and Prevention (CDC) in...

I don't understand why in Appendix F. Risk of Bias for Randomized Controlled Trials (starting on page 228) all trials received the label "Yes" for the question "Outcomes Pre-specified" Does anyone understand what they mean?

My reservations have little to do with the specifics of the test but with the separation between ME/CFS patients and ICF patients. My expectation is that, if there is a true effect, ME/CFS diagnostic criteria would not have separated people almost perfectly so that all ME/CFS patients show a...

Ok but why the almost perfect separation between those who meet ME/CFS criteria and those who don't? If one time in the future something significant is found, it would be really weird that ME/CFS diagnostic criteria would have already separated patients into those who have the abnormality and...

I agree with Hutan. This looks too good to be true. All the male ME/CFS patients had a reduction in workload while all the male ICF patients had an increase in workload at the second CPET. Given how arbitrary ME/CFS diagnostic criteria are, this seems extremely unlikely. Even if there was a...

Summary of the CDC evidence review The Centers for Disease Control and Prevention (CDC) have commissioned a systematic review on the management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The review is conducted by the Pacific Northwest Evidence-Based Practice Center (EPC) at...

Thanks, yes I plan to work something out if I find the energy and submit it to a journal.

Split from Effect of Galantamine Hydrobromide in Chronic Fatigue Syndrome A Randomized Controlled Trial, 2004, Blacker et al.. The quote in this post refers to the Blacker paper. This might also be of interest. It's the main result of an open-label study by Vermeulen et al. published in 2004...

New blog post: Problems with the MetaBLIND study The MetaBLIND study is likely the largest study on the effect of blinding in randomized trials to date. Contrary to expectations, the study did not find a relationship between exaggerated treatment effects and lack of blinding of patients...

Seems that the study was funded by a pharmaceutical company. It reads: Some of the researchers involved in the study: Behan in the UK, Van der Meer in the Netherlands, De Meirleir in Belgium, Klimas in the US etc. Michael Sharpe was on the Data Monitoring Committee.

Seems that they have also excluded this Belgian RCT on methylphenidate because of "inadequate duration". Given the many flaws the studies that were included, have I think it would be best if they included studies with inadequate duration and simply highlight their limitation and shortcoming...

This is apparently the largest drug trial ever done in ME/CFS patients. It tested the use of galantamine (an acetyl-cholinesterase inhibitor that is used to treat cognitive decline in for example Alzheimer's) at 4 different doses against a placebo. 434 ME/CFS participated in the trial in...

(Note that this is an old study from 2004) Abstract 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...

It seems that this trial by Cleare and Wessely on hydrocortisone reported in the Lancet was excluded (I suppose because the treatment duration of 1 month was too short) Cleare AJ, Heap E, Malhi GS, et al. Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet...

Thanks. I think it is sometimes underestimated how influential this Dutch group has been. They have for example published by far the most trials on ME/CFS. I also think they were more radical than Sharpe or Wessely: patients were encouraged to no longer see themselves as CFS patients. One...

They did include the following study: Stubhaug B, Lie SA, Ursin H, et al. Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial. Br J Psychiatry. 2008;192(3):217-23. doi: 10.1192/bjp.bp.106.031815. PMID: 18310583 This is weird...

There are a couple of non-randomized studies that showed that employment/hours worked do not increase after CBT. My personal impression is that a lot of doctors and policymakers think that CBT is an evidence-based rehabilitation and therefore it must be good to get patients back to work. It's...

The report mentions both the PACE authors' post-hoc definition of recovery and the one they had specified in the protocol. Unfortunately, they used the former in their meta-analyses. For example here:

It seems that the big CBT trial by Prins et al. (published in 2001 in The Lancet) was excluded because it didn't use the Fukuda criteria correctly. The report says: Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised...

Just noticed that Peter Gladwell was also part of this trial on CBT for ME/CFS. The trial report states "The decision was taken to include structured exercise within the CBT group." Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group...