Severity and worsening of fatigue among individuals with multiple sclerosis

BackgroundFatigue is associated with reduced quality of life and social participation, and poor employment outcomes. However, most studies examining fatigue are limited by small sample sizes or short follow-up periods. ObjectiveTo characterize the natural history of fatigue. MethodsThe North American Research Committee on Multiple Sclerosis Registry participants with >= 7 years of longitudinal data between 2004 and 2019 and a relapsing disease course were included. A subset of participants enrolled within 5 years of diagnosis was identified. The Fatigue Performance Scale assessed fatigue and >= 1-point increase in Fatigue Performance Scale sustained at the next survey defined fatigue worsening. ResultsOf 3057 participants with longitudinal data, 944 were within 5 years of multiple sclerosis diagnosis. Most participants (52%) reported fatigue worsening during follow-up. Median time to fatigue worsening ranged from 3.5 to 5 years at lower levels of index fatigue. Fatigue worsening was associated with lower annual income, increasing disability, lower initial fatigue level, taking injectable disease-modifying therapies and increasing depression levels in the relapsing multiple sclerosis participants. ConclusionMost multiple sclerosis participants early in their disease suffer from fatigue and at least half reported fatigue worsening over time. Understanding factors associated with fatigue may help to identify populations most at risk of fatigue worsening will be informative for the overall management of patients with multiple sclerosis.

Automated summary

Fatigue is commonly experienced by multiple sclerosis patients, with a majority reporting worsening of fatigue over time. Factors associated with fatigue worsening include lower income, higher disability, lower initial fatigue level, use of injectable disease-modifying therapies, and increased levels of depression.