Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue

Chu, S. H., Zhao, X., Komber, A., Cheyne, J., Wu, S., Cowey, E. , Kutlubaev, M. and Mead, G. (2023) Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue. International Journal of Stroke, (doi: 10.1177/17474930231196648) (Early Online Publication)

Abstract

Background: Post-stroke fatigue (PSF) affects around 50% of stroke survivors. Previous systematic reviews of randomized controlled trials found insufficient evidence to guide practice, but most excluded Chinese studies. Furthermore, their searches are now out-of-date. Aims: To systematically review and perform a meta-analysis of randomized placebo-controlled trials of pharmacological interventions for treating PSF. Methods: We screened Airitri, CNKI, VIP, CINAHL, ClinicalTrials.gov, CENTRAL, Cochrane Stroke Group Trial Register, EMBASE, EU Clinical Trial Register, ISRCTN, MEDLINE, PsycINFO, Wanfang, and WHO ICTRP up to 11 November 2022. Our primary outcome was fatigue severity. We conducted subgroup analysis by drug type and sensitivity analysis after excluding the trials at high risk of bias. Secondary outcomes included mood and quality of life. Results: We screened 33,297 citations and identified 10 published completed trials, 6 unpublished completed trials, and 6 ongoing trials. Pharmacological treatments were associated with lower fatigue severity at the end of treatment (10 published completed trials, 600 participants, pooled standardized mean difference (SMD) = −0.80, 95% confidence interval (CI): −1.29 to −0.31; I2 = 86%, p < 0.00001), but not at follow-up (265 participants, pooled SMD = −0.14, 95% CI: −0.38 to 0.10; I2 = 0, p = 0.51). However, these trials were small and had considerable risk of bias. Beneficial effects were seen in trials with low risk of bias on randomization, missing outcome data, and reporting bias. There were insufficient data on secondary outcomes for meta-analysis, but six trials reported improved quality of life. Conclusion: There is insufficient evidence to support a particular pharmacological treatment for PSF, thus current clinical guidelines do not require amendment.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cowey, Professor Eileen and Cheyne, Mr Joshua
• Authors: Chu, S. H., Zhao, X., Komber, A., Cheyne, J., Wu, S., Cowey, E., Kutlubaev, M., and Mead, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: International Journal of Stroke
• Publisher: SAGE Publications
• ISSN: 1747-4930
• Published Online: 07 September 2023