A study of commonly used treatments for people with multiple sclerosis, both medical and behavioral interventions, and a combination of the two, resulted in meaningful improvements in fatigue. Of nearly 3 million people with MS worldwide, up to 90 percent experience fatigue. Nearly half describe it as their most disabling symptom.

The University of Michigan led a randomized clinical trial that compared the effectiveness of modafinil (a wake-promoting medication used to treat sleepiness in people with sleep disorders) and cognitive behavioral therapy on reducing fatigue. The trial was conducted with more than 300 adults with MS whose symptoms interfered with their daily activities.

Overall, investigators found treatment with either modafinil or CBT alone, which was delivered over the phone, was linked to significant reductions of fatigue over 12 weeks. 

A combination of both treatments also worked as well as each individual treatment but did not result in better fatigue scores than the independent interventions.

The study’s authors said the research offers new evidence to show that both CBT and modafinil are comparably effective for MS fatigue, which could shape treatment approaches to one of the most challenging symptoms experienced by people with MS.

More than 60 percent of participants in each study group reported clinically meaningful improvement in fatigue, which was measured with a survey called the Modified Fatigue Impact Scale.

The research used a real world approach that more closely resembled clinical practice rather than traditional clinical trials and included stakeholders with MS who helped design the study.

The researchers said the treatments, both individually and as a combination, should be considered as potential options for people with MS with chronic, problematic fatigue.

The findings were published in the journal Lancet Neurology.