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Lookup NU author(s): Professor David Jones,
Professor Julia Newton
Background: Fatigue is a debilitating symptom which frequently impairs the quality of life of patients with primary biliary cirrhosis (PBC). Although the mechanisms underpinning fatigue in PBC remain unclear, there is an emerging consensus that CNS mechanisms play a key role. It has recently been shown that there is a strong association between abnormalities in sleep regulation, in particular excessive daytime somnolence, and fatigue severity in PBC. The CNS-acting drug modafinil has an established role in the treatment of excessive daytime somnolence in non-liver disease states. Aim: To explore, in an open label study, the responses of PBC patients suffering from significant daytime somnolence and associated fatigue to modafinil therapy. Methods: All patients in the series (n = 21) underwent daytime somnolence assessment using the Epworth Sleepiness Scale and PBC symptom assessment using the PBC-40, a multi-domain, disease specific, psychometrically robust quality of life measure. Modafinil was started at a dose of 100 mg/day and was titrated according to tolerability and response. Patients underwent repeat Epworth Sleepiness Scale and PBC-40 assessment after 2 months of treatment. Results: Significant improvement was seen in Epworth Sleepiness Scale scores with modafinil therapy [15 ± 3 vs. 8 ± 6, P < 0.0005 (intention-to-treat analysis)]. An equally significant improvement in fatigue severity was also seen [PBC-40 fatigue domain score (46 ± 6 vs. 34 ± 12, P < 0.0001) (intention-to-treat analysis)]. Conclusions: Open label modafinil therapy was associated, where tolerated by patients, with improvement in excessive daytime somnolence and associated fatigue in PBC. Further study in placebo-controlled trials is warranted. © 2007 The Authors.
Author(s): Jones DEJ, Newton JL
Publication type: Article
Publication status: Published
Journal: Alimentary Pharmacology and Therapeutics
ISSN (print): 0269-2813
ISSN (electronic): 1365-2036
Publisher: Wiley-Blackwell Publishing Ltd.
PubMed id: 17270003
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