Feasibility study of a randomised controlled trial to investigate the treatment of sarcoidosis-associated fatigue with methylphenidate (FaST-MP): a study protocol

Christopher Atkins, Richard Fordham, Allan B Clark, Andrea Stockl, Andrew P Jones, Andrew M Wilson, Christopher Atkins, Richard Fordham, Allan B Clark, Andrea Stockl, Andrew P Jones, Andrew M Wilson

Abstract

Introduction: Fatigue is a frequent and troublesome manifestation of chronic sarcoidosis. This symptom can be debilitating and difficult to treat, with poor response to the treatment. Symptomatic management with neurostimulants, such as methylphenidate, is a possible treatment option. The use of such treatment strategies is not without precedent and has been trialled in cancer-related fatigue. Their use in sarcoidosis requires further evaluation before it can be recommended for clinical practice.

Methods and analysis: The Fatigue and Sarcoidosis-Treatment with Methylphenidate study is a randomised, controlled, parallel-arm and feasibility trial of methylphenidate for the treatment of sarcoidosis-associated fatigue. Patients are eligible if they have a diagnosis of sarcoidosis, significant fatigue (measured using the Fatigue Assessment Scale) and have stable disease. Up to 30 participants will be randomly assigned to either methylphenidate (20 mg two times per day) or identical placebo in a 3:2 ratio for 24 weeks. The primary objective is to collect data determining the feasibility of a future study powered to determine the clinical efficacy of methylphenidate for sarcoidosis-associated fatigue. The trial is presently open and will continue until July 2018.

Ethics and dissemination: Ethical approval for the study was granted by the Cambridge Central Research Ethics Committee on 21 June 2016 (reference 16/EE/0087) and was approved and sponsored by the Norfolk and Norwich University Hospital (reference 190280). Clinical Trial Authorisation (EudraCT number 2016-000342-60) from the Medicines and Healthcare products Regulatory Agency (MHRA) was granted on 19 April 2016. Results will be presented at relevant conferences and submitted to appropriate journals following trial closure and analysis.

Trial registration number: NCT02643732; Pre-results.

Keywords: Fatigue; Interstitial Lung Disease; Sarcoidosis.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Patient flow through trial. FBC, full blood count; LFT, liver function test; PIS, patient information sheet; TFT, thyroid function test; U&E, urea and electrolytes.

References

    1. Gribbin J, Hubbard RB, Le Jeune I, et al. . Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK. Thorax 2006;61:980–5. 10.1136/thx.2006.062836
    1. Marcellis RG, Lenssen AF, Elfferich MD, et al. . Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J 2011;38:628–34. 10.1183/09031936.00117710
    1. Drent M, Lower EE, De Vries J. Sarcoidosis-associated fatigue. Eur Respir J 2012;40:255–63. 10.1183/09031936.00002512
    1. Michielsen HJ, Drent M, Peros-Golubicic T, et al. . Fatigue is associated with quality of life in sarcoidosis patients. Chest 2006;130:989–94. 10.1378/chest.130.4.989
    1. Mostard RL, Voo S, van Kroonenburgh MJ, et al. . Inflammatory activity assessment by F18 FDG-PET/CT in persistent symptomatic sarcoidosis. Respir Med 2011;105:1917–24. 10.1016/j.rmed.2011.08.012
    1. Zheng L, Teschler H, Guzman J, et al. . Alveolar macrophage TNF-alpha release and BAL cell phenotypes in sarcoidosis. Am J Respir Crit Care Med 1995;152:1061–6. 10.1164/ajrccm.152.3.7663784
    1. Keller M, Mazuch J, Abraham U, et al. . A circadian clock in macrophages controls inflammatory immune responses. Proc Natl Acad Sci U S A 2009;106:21407–12. 10.1073/pnas.0906361106
    1. Darko DF, Miller JC, Gallen C, et al. . Sleep electroencephalogram delta-frequency amplitude, night plasma levels of tumor necrosis factor alpha, and human immunodeficiency virus infection. Proc Natl Acad Sci U S A 1995;92:12080–4. 10.1073/pnas.92.26.12080
    1. De Kleijn WP, Drent M, Vermunt JK, et al. . Types of fatigue in sarcoidosis patients. J Psychosom Res 2011;71:416–22. 10.1016/j.jpsychores.2011.09.006
    1. de Kleijn WP, Drent M, De Vries J. Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis. Br J Health Psychol 2013;18:439–52. 10.1111/j.2044-8287.2012.02094.x
    1. Lal C, Medarov BI, Judson MA. Interrelationship between sleep-disordered breathing and sarcoidosis. Chest 2015;148:1105–14. 10.1378/chest.15-0584
    1. Fleischer M, Hinz A, Brähler E, et al. . Factors associated with fatigue in sarcoidosis. Respir Care 2014;59:1086–94. 10.4187/respcare.02080
    1. Atkins C, Wilson AM. Managing fatigue in sarcoidosis - A systematic review of the evidence. Chron Respir Dis 2017;14:161–73. 10.1177/1479972316661926
    1. Minton O, Richardson A, Sharpe M, et al. . Drug therapy for the management of cancer-related fatigue. The Cochrane database of systematic reviews 2010;7.
    1. Mendonça DA, Menezes K, Jog MS. Methylphenidate improves fatigue scores in Parkinson disease: a randomized controlled trial. Mov Disord 2007;22:2070–6. 10.1002/mds.21656
    1. Breitbart W, Rosenfeld B, Kaim M, et al. . A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Arch Intern Med 2001;161:411–20. 10.1001/archinte.161.3.411
    1. Lower EE, Harman S, Baughman RP. Double-blind, randomized trial of dexmethylphenidate hydrochloride for the treatment of sarcoidosis-associated fatigue. Chest 2008;133:1189–95. 10.1378/chest.07-2952
    1. Lower EE, Malhotra A, Surdulescu V, et al. . Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Symptom Manage 2013;45:159–69. 10.1016/j.jpainsymman.2012.02.016
    1. Baughman RP, Drent M, Culver DA, et al. . Endpoints for clinical trials of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2012;29:90–8.
    1. De Vries J, Michielsen H, Van Heck GL, et al. . Measuring fatigue in sarcoidosis: the Fatigue Assessment Scale (FAS). Br J Health Psychol 2004;9:279–91. 10.1348/1359107041557048
    1. Lavretsky H, Reinlieb M, St Cyr N, et al. . Citalopram, methylphenidate, or their combination in geriatric depression: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry 2015;172:561–9. 10.1176/appi.ajp.2014.14070889
    1. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005;4:287–91. 10.1002/pst.185
    1. Murtagh MJ, Thomson RG, May CR, et al. . Qualitative methods in a randomised controlled trial: the role of an integrated qualitative process evaluation in providing evidence to discontinue the intervention in one arm of a trial of a decision support tool. Qual Saf Health Care 2007;16:224–9. 10.1136/qshc.2006.018499

Source: PubMed

3
Prenumerera