A COCHRANE REVIEW OF INTERVENTIONS FOR MANAGING FATIGUE IN INFLAMMATORY BOWEL DISEASE

Background: Fatigue is a common and burdensome symptom experienced by individuals with inflammatory bowel disease (IBD). The subjective, complex nature of fatigue can often hamper its’ management, and the effectiveness of treatments for fatigue in IBD remains unknown. The aim of this Cochrane review was to assess the efficacy and safety of pharmacological and non-pharmacological interventions for managing fatigue in IBD. Methods: A systematic search was conducted up to July 2018, and the search was rerun in October 2019. All randomised controlled trials (RCTs) of pharmacological and non-pharmacological interventions in children or adults with IBD, where fatigue was assessed as a primary or secondary outcome were included. Data were extracted and study quality was independently assessed by two authors. Standard Cochrane methodological procedures were used. Results: Fourteen RCTs were included (3741 participants; all adults; 6 in Crohn’s disease (CD); 2 in ulcerative colitis (UC); 6 in both CD and UC), with five potentially relevant studies identified from the updated search (to be assessed for inclusion at the next update). The interventions varied widely and included nine pharmacological trials, four non-pharmacological trials, and one multimodular trial. Only four trials were designed specifically as interventions for managing fatigue and one meta-analysis was possible, due to the diversity and limited number of studies for each intervention. We found that adalimumab 40mg administered every other week (only for those known to respond to adalimumab induction therapy), self-directed stress management and physical activity advice may reduce fatigue but the evidence is very uncertain. The evidence suggest ferric maltol results in a slight increase in fatigue and electroacupuncture may result in a large reduction in fatigue and increase in quality of life. There is no evidence of effect for adalimumab maintenance therapy, adalimumab administered 40mg weekly, agaricus blazei murill-based mushroom extract, omega 3, guided stress management or cognitive behavioural therapy that is likely to have a clinically meaningful improvement on fatigue. Reporting in some of the trials was insufficient to assess the efficacy and safety of some therapies, including vitamin D3 supplementation, ferumoxytol, vedolizumab, tight control customised management and solution focused therapy. Conclusions: The effects of pharmacological and non-pharmacological interventions on fatigue in individuals with IBD are uncertain. It is difficult to draw firm conclusions regarding the efficacy and safety of interventions, as there is insufficient quantity and quality of evidence available. Further RCTs with larger number of participants are required to assess the potential benefits and harms of therapies, particularly interventions specifically designed for fatigue management.