Background There is evidence that pharmacological interventions, including biologic therapies, can improve inflammation, disease activity and function in inflammatory rheumatic and musculoskeletal diseases (I-RMDs), and fatigue has increasingly been included as a secondary outcome of I-RMDs clinical trials. However, no systematic review (SR) has established the evidence for the pharmacological management of fatigue in people with I-RMD [1,2].

Objectives To identify the best evidence on the efficacy of pharmacological interventions in reducing fatigue in people with I-RMDs and to summarise their safety in the identified studies to inform EULAR recommendations for the management of fatigue in people with I-RMD.

Methods Systematic review of adults with I-RMD conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction, and synthesis performed by two reviewers independently. Data pooled in statistical meta-analyses.

Results From a total of 4,150 records, 454 were selected for full-text review, 105 fulfilled the inclusion criteria, and 19 RCTs were included in meta-analyses. Adalimumab was superior to placebo in reducing fatigue at 52 and 12 weeks (wk) in rheumatoid arthritis (RA) (mean difference [MD]=-2.25, p=0.03; MD=-3.03, p<0.001; respectively) and psoriatic arthritis (MD=-3.16, p=0.26). Golimumab (24wk: MD=-5.27, p<0.001), baricitinib (24wk: MD=-4.06, p<0.001), sarilumab (24wk: MD=-3.15, p<0.001), tocilizumab (24wk: MD=-3.69, p<0.001) and tofacitinib (12wk: MD=-4.44, p<0.001) were also superior to placebo in reducing fatigue in RA. A dose/effect relationship was observed for sarilumab, tocilizumab and tofacitinib. In spondyloarthritis, secukinumab was superior to placebo in reducing fatigue at 16wk (MD=-4.15, p<0.001), with a dose/effect relationship also observed (Figure 1). The narrative results of the RCTs not included in the meta-analysis indicated that several other pharmacological interventions were efficacious in reducing fatigue, with reassuring safety results.

Conclusion Pharmacological interventions are efficacious and safe for the management of fatigue in people with I-RMD.

References [1]Almeida C, Choy EH, Hewlett S, et al. Biologic interventions for fatigue in rheumatoid arthritis. The Cochrane database of systematic reviews. 2016;2016:Cd008334.

[2]Choy EH. Effect of biologics and targeted synthetic disease-modifying anti-rheumatic drugs on fatigue in rheumatoid arthritis. Rheumatology. 2019;58:v51-v5.

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Figure 1.

The summary of the meta-analyses, PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, SpA: Spondyloarthritis, wk: weeks

Acknowledgements B Farisogullari and E Santos contributed equally to the manuscript.

Disclosure of Interests Bayram Farisogullari: None declared, Eduardo Santos: None declared, Emma Dures: None declared, Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB.