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- Title
Effectiveness of Long-term Doxycycline Treatment and Cognitive-Behavioral Therapy on Fatigue Severity in Patients with Q Fever Fatigue Syndrome (Qure Study): A Randomized Controlled Trial.
- Authors
Keijmel, Stephan P.; Delsing, Corine E.; Bleijenberg, Gijs; van der Meer, Jos W. M.; Donders, Rogier T.; Leclercq, Monique; Kampschreur, Linda M.; van den Berg, Michel; Sprong, Tom; Nabuurs-Franssen, Marrigje H.; Knoop, Hans; Bleeker-Rovers, Chantal P.
- Abstract
Background. Approximately 20% of patients with acute Q fever will develop chronic fatigue, referred to as Q fever fatigue syndrome (QFS). The objective of this randomized controlled clinical trial was to assess the efficacy of either long-term treatment with doxycycline or cognitive-behavioral therapy (CBT) in reducing fatigue severity in patients with QFS. Methods. Adult patients were included who met the QFS criteria according to the Dutch guideline: a new onset of severe fatigue lasting =6 months with significant disabilities, related to an acute Q fever infection, without other somatic or psychiatric comorbidity explaining the fatigue. Using block randomization, patients were randomized between oral study medication and CBT (2:1) for 24 weeks. Second, a double-blind randomization between doxycycline (200 mg/day, once daily) and placebo was performed in the medication group. Primary outcome was fatigue severity at end of treatment (EOT; week 26), assessed with the Checklist Individual Strength subscale Fatigue Severity. Results. Of 155 patients randomized, 154 were included in the intention-to-treat analysis (doxycycline, 52; placebo, 52; CBT, 50). At EOT, fatigue severity was similar between doxycycline (40.8 [95% confidence interval {CI}, 37.3-44.3]) and placebo (37.8 [95% CI, 34.3-41.2]; difference, doxycycline vs placebo, -3.0 [97.5% CI, -8.7 to 2.6]; P = .45). Fatigue severity was significantly lower after CBT (31.6 [95% CI, 28.0-35.1]) than after placebo (difference, CBT vs placebo, 6.2 [97.5% CI, .5-11.9]; P = .03). Conclusions. CBT is effective in reducing fatigue severity in QFS patients. Long-term treatment with doxycycline does not reduce fatigue severity in QFS patients compared to placebo.
- Subjects
Q fever; CHRONIC fatigue syndrome treatment; DOXYCYCLINE; COGNITIVE therapy; TREATMENT effectiveness; DRUG efficacy; RANDOMIZED controlled trials; THERAPEUTICS
- Publication
Clinical Infectious Diseases, 2017, Vol 64, Issue 8, p998
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cix013