The long wait for a breakthrough in chronic fatigue syndromeBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2087 (Published 05 May 2015) Cite this as: BMJ 2015;350:h2087
- Andrew R Lloyd, professor1,
- Jos W M van der Meer, professor2
- 1Inflammation and Infection Research Centre, University of New South Wales, Sydney 2052, Australia
- 2Department of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Correspondence to: A R Lloyd
There hasn’t been much good news for patients with the prevalent but enigmatic disorder chronic fatigue syndrome (also referred to as myalgic encephalomyelitis). Over decades, research into the pathophysiology has failed to find convincing evidence of either persistent infection or immunological, endocrine, or metabolic change, and has rejected simplistic notions of depression (typical or atypical) or primary sleep disorder. Several notable “breakthroughs” have failed independent replication. The most noteworthy is the recent rise and fall of xenotropic murine leukaemia virus related virus (XMRV) as the cause, which was ultimately established as a murine DNA laboratory contaminant.1 Similarly, an exhaustive array of randomised controlled trials seeking curative outcomes from antiviral, immunological, hormonal, antidepressant, and many other therapies have failed to show any benefit over placebo, or failed the replication test.
Where then is the progress? Firstly, there is reproducible evidence implicating certain infections as a trigger—notably, infectious mononucleosis caused by Epstein-Barr virus, but also infection with other pathogens.2 Secondly, there is clear evidence that a substantial proportion of patients have a coexisting mood disorder, and sometimes a sleep-wake disorder, and that these conditions may exacerbate or perpetuate the …