Background:Approximately 20% of patients with acute Q fever will develop chronic fatigue, referred to as Q fever fatigue syndrome (QFS). The objective of this randomized controlled clinical trial was to assess the efficacy of either long-term treatment with doxycycline or cognitive-behavioral therapy (CBT) in reducing fatigue severity in patients with QFS. Methods:Adult patients were included who met the QFS criteria according to the Dutch guideline: a new onset of severe fatigue lasting ≥6 months with significant disabilities, related to an acute Q fever infection, without other somatic or psychiatric comorbidity explaining the fatigue. Using block randomization, patients were randomized between oral study medication and CBT (2:1) for 24 weeks. Second, a double-blind randomization between doxycycline (200 mg/day, once daily) and placebo was performed in the medication group. Primary outcome was fatigue severity at end of treatment (EOT; week 26), assessed with the Checklist Individual Strength subscale Fatigue Severity. Results:Of 155 patients randomized, 154 were included in the intention-to-treat analysis (doxycycline, 52; placebo, 52; CBT, 50). At EOT, fatigue severity was similar between doxycycline (40.8 [95% confidence interval {CI}, 37.3-44.3]) and placebo (37.8 [95% CI, 34.3-41.2]; difference, doxycycline vs placebo, -3.0 [97.5% CI, -8.7 to 2.6]; P = .45). Fatigue severity was significantly lower after CBT (31.6 [95% CI, 28.0-35.1]) than after placebo (difference, CBT vs placebo, 6.2 [97.5% CI, .5-11.9]; P = .03). Conclusions:CBT is effective in reducing fatigue severity in QFS patients. Long-term treatment with doxycycline does not reduce fatigue severity in QFS patients compared to placebo. Clinical Trials Registration:NCT01318356.

译文

背景:大约20%的急性Q发热患者会发展成慢性疲劳,称为Q发热疲劳综合征(QFS)。这项随机对照临床试验的目的是评估强力霉素长期治疗或认知行为疗法(CBT)减轻QFS患者疲劳严重程度的功效。
方法:纳入符合荷兰指南QFS标准的成年患者:新出现的严重疲劳持续时间≥6个月,伴有严重的残疾,与急性Q热感染有关,而没有其他躯体或精神病合并症来解释疲劳。使用区组随机分组,将患者在口服研究药物和CBT(2:1)之间随机分组,持续24周。其次,在药物治疗组中,将强力霉素(200 mg /天,每天一次)与安慰剂进行双盲随机分组。主要结局是治疗结束时(EOT;第26周)的疲劳严重程度,该评估通过核对表“个人力量”子量表疲劳强度进行评估。
结果:在随机分组的155例患者中,有154例被纳入意向性治疗分析(强力霉素52例;安慰剂52例; CBT 50例)。在EOT时,强力霉素(40.8 [95%置信区间{CI},37.3-44.3])和安慰剂(37.8 [95%CI,34.3-41.2])之间的疲劳严重程度相似;差异在于强力霉素与安慰剂之间为-3.0 [97.5%] CI,-8.7至2.6]; P = 0.45)。 CBT后的疲劳严重程度(31.6 [95%CI,28.0-35.1])显着低于安慰剂后(差异,CBT vs安慰剂为6.2 [97.5%CI,.5-11.9]; P = .03)。
结论:CBT可有效减轻QFS患者的疲劳程度。与安慰剂相比,长期用强力霉素治疗不会降低QFS患者的疲劳严重程度。
临床试验注册:NCT01318356。

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