• Megan E Roerink, BredieSebastian J HSJHFrom Radboud University Medical Centre, Nijmegen, and University of Amsterdam, Amsterdam, the Netherlands; and University of Colorado Denver, Aurora, Colorado., Michael Heijnen, Charles A Dinarello, Hans Knoop, and Van der MeerJos W MJWMFrom Radboud University Medical Centre, Nijmegen, and University of Amsterdam, Amsterdam, the Netherlands; and University of Colorado Denver, Aurora, Colorado..
• From Radboud University Medical Centre, Nijmegen, and University of Amsterdam, Amsterdam, the Netherlands; and University of Colorado Denver, Aurora, Colorado.
• Ann. Intern. Med. 2017 Apr 18; 166 (8): 557-564.

BackgroundInterleukin-1 (IL-1), an important proinflammatory cytokine, is suspected to play a role in chronic fatigue syndrome (CFS).ObjectiveTo evaluate the effect of subcutaneous anakinra versus placebo on fatigue severity in female patients with CFS.DesignRandomized, placebo-controlled trial from July 2014 to May 2016. Patients, providers, and researchers were blinded to treatment assignment. (ClinicalTrials.gov: NCT02108210).SettingUniversity hospital in the Netherlands.Patients50 women aged 18 to 59 years with CFS and severe fatigue leading to functional impairment.InterventionParticipants were randomly assigned to daily subcutaneous anakinra, 100 mg (n = 25), or placebo (n = 25) for 4 weeks and were followed for an additional 20 weeks after treatment (n = 50).MeasurementsThe primary outcome was fatigue severity, measured by the Checklist Individual Strength subscale (CIS-fatigue) at 4 weeks. Secondary outcomes were level of impairment, physical and social functioning, psychological distress, and pain severity at 4 and 24 weeks.ResultsAt 4 weeks, 8% (2 of 25) of anakinra recipients and 20% (5 of 25) of placebo recipients reached a fatigue level within the range reported by healthy persons. There were no clinically important or statistically significant differences between groups in CIS-fatigue score at 4 weeks (mean difference, 1.5 points [95% CI, -4.1 to 7.2 points]) or the end of follow-up. No statistically significant between-group differences were seen for any secondary outcome at 4 weeks or the end of follow-up. One patient in the anakinra group discontinued treatment because of an adverse event. Patients in the anakinra group had more injection site reactions (68% [17 of 25] vs. 4% [1 of 25]).LimitationSmall sample size and wide variability in symptom duration; inclusion was not limited to patients with postinfectious symptoms.ConclusionPeripheral IL-1 inhibition using anakinra for 4 weeks does not result in a clinically significant reduction in fatigue severity in women with CFS and severe fatigue.Primary Funding SourceInterleukin Foundation and an independent donor who wishes to remain anonymous.

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