Aspirin as good as amantadine for fatigue? Or not?

Epub: Shaygannejad et al. Comparison of the effect of aspirin and amantadine for the treatment of fatigue in multiple sclerosis: a randomized, blinded, crossover study. Neurol Res. 2012 Sep 12.

OBJECTIVES: The purpose of this study was to compare the relative efficacy of acetylsalicylic acid (ASA) and amantadine for the treatment of fatigue in MS.

METHODS: A 10-week, randomized double-blind crossover clinical trial conducted from October 2009 to September 2010. Fifty-two MSers presenting fatigue at 21 to 53 years of age were randomly allocated to the two treatment groups. The first group received amantadine (100 mg twice daily) for a total of 4 weeks. The second group received ASA (500 mg once daily) for four weeks. After a 2-week washout period, they crossed over to the alternative treatment for 4 weeks. MSers were rated at baseline and the end of each phase with the Fatigue Severity Scale (FSS).

RESULTS: ASA appeared to be equivalent in efficacy and safety to amantadine. A significant decrease in FSS occurred in both groups. Of the 26 MSers treated with amantadine, the mean (SD) of FSS decreased from 4.8 (1.4) to 4.0 (1.4) (P<0.001). In the 26 MSers treated with ASA, the mean (SD) of FSS decreased from 4.6 (1.4) to 3.5 (1.5) (P<0.001).

DISCUSSION: This study demonstrates that both ASA and amantadine significantly reduce MS-related fatigue. Both ASA and amantadine have previously been shown to reduce fatigue, and we postulate that treatment with ASA and amantadine may have similar benefits.

"Why was there a placebo phase? A lot of people are unconvinced about the effectiveness of Amantadine. How would aspirin work? It could lower body temperature or work as a an anti-inflammatory agent. Clearly more work needs to be done. On the upside aspirin is very cheap, but the down side it is associated with an increase risk of bleeding; the latter is not insignificant. Would I prescribe it? Not on this evidence. "

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