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Anakinra does not seem to improve fatigue severity in women with chronic fatigue syndrome

March 06, 2017

1. Anakinra does not improve fatigue severity in women with chronic fatigue syndrome
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2391

URL goes live when the embargo lifts

The anti-inflammatory biologic drug anakinra (interleukin-1 receptor antagonist) does not reduce fatigue severity in women with chronic fatigue syndrome (CFS). The findings of a randomized, placebo-controlled trial are published in Annals of Internal Medicine.

CFS is characterized by severe, persistent, and disabling fatigue. In order to fulfill the Centers for Disease Control and Prevention (CDC) criteria for CFS, patients have to report at least four of eight accompanying symptoms in addition to fatigue (headache, muscle plain, etc.). Interleukin-1 (IL-1), a pro-inflammatory cytokine, has been associated with CFS in some studies. There is extensive experience with blocking IL-1 in a variety of diseases with the IL-1 receptor antagonist anakinra. Several studies in inflammatory and non-inflammatory illnesses have assessed the effect of IL-1 inhibition on fatigue severity, and most have found positive effects of this intervention.

Researchers from Radboud University Medical Centre in the Netherlands conducted a randomized, placebo-controlled trial to evaluate the effects of anakinra injections versus placebo on fatigue severity in patients with CFS. Since CFS typically affects women, the researchers included only female patients to investigate a homogeneous group. Fifty women with severe fatigue leading to functional impairment were randomly assigned to receive daily anakinra injections (100 mg) or placebo for 4 weeks, followed by an additional 20 weeks of follow-up after treatment.

Fatigue severity, the primary outcome, was assessed via questionnaire at 4 and 24 weeks. The secondary outcomes of level of impairment, physical and social functioning, psychological distress, and pain severity were assessed at 4 and 24 weeks. The researchers found no clinically meaningful difference in fatigue severity with anakinra. They also found no statistically significant differences between groups for secondary outcomes. They conclude that if IL-1 plays a role in CFS, blocking it with anakinra has no effect.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the author, Megan Roerink, MD, please contact nieuws@radboudumc.nl

2. Disrupting the flow of international medical graduates to the U.S. will have a negative effect on patient care
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0505 URL goes live when the embargo lifts

A commentary published in Annals of Internal Medicine suggests that disrupting the flow of international medical graduates who come to the United States to complete their training will have a negative impact on patient care.

Currently, internationally educated physicians account for approximately one quarter of the practicing physician workforce in the U.S. They come to the U.S. for many reasons, including the desire to engage in care that, based on their home country resource constraints, is not available. While international medical graduates enter many different medical specialties, internal medicine is by far the most common. Over the past decade, there have been calls for the U.S. to train its own physicians and stop relying on economically underdeveloped nations to augment the workforce. However, there is no clear path to self-sufficiency. International graduates are needed to fill practice gaps left by U.S. graduates who may not choose careers in certain specialties or practice in undeserved areas.

In his commentary, William W. Pinsky, MD, President and CEO of the Educational Commission for Foreign Medical Graduates (ECFMG), located in Philadelphia, describes the current vetting process for international medical graduates and outlines their importance to quality healthcare delivery in the U.S. and the subsequent contribution to the safety of the country.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the author, William Pinsky, MD, please contact Liz Ingram at eingraham@ecfmg.org or 215-823-2108.
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Also new in this issue:

Developing Recommendations for Evidence-Based Clinical Preventive Services for Diverse Populations: methods of the U.S. Preventive Services Task Force

Kirsten Bibbins-Domingo, PhD, MD, MAS; Evelyn Whitlock, MD, MPH; Tracy Wolff, MD, MPH; Quyen Ngo-Metzger, MD, MPH; William R. Phillips, MD, MPH; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Jennifer S. Lin, MD, MCR; Carol M. Mangione, MD, MSPH; Ann E. Kurth, PhD, CNM, MSN, MPH; Francisco A.R. Garc?´a, MD, MPH; Susan J. Curry, PhD; David C. Grossman, MD, MPH; C. Seth Landefeld, MD; John W. Epling Jr., MD, MSEd; and Albert L. Siu, MD, MSPH

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2656

American College of Physicians

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