Florinef alone ineffective
Patients with CFS (chronic
fatigue syndrome) are more likely than healthy persons to develop neurally
mediated hypotension (NMH), where upright posture provokes a dramatic drop in
blood pressure. A recent study, published in The Journal of the American
Medical Association, found that a steroid hormone drug often used to treat
NMH, fludrocortisone (Florinef), is not effective by itself in alleviating the
symptoms of CFS patients.
Researchers at Johns Hopkins University School
of Medicine and the National Institute of Allergy and Infectious Diseases
studied 100 adults with CFS and NMH. Half of the patients received Florinef and
half received placebo for nine weeks. Only 14% of those treated with Florinef
reported notable improvement compared to 10% in the placebo
Researchers caution that lack of symptomatic improvement with
Florinef alone does not disprove the hypothesis that NMH could be contributing
to CFS symptoms.
Since 1996 when the study began, other clinical
trials found that four different drugs, some of which have a more direct effect
on blood pressure than Florinef, can benefit people who experience recurrent
fainting due to NMH. Further studies are needed to determine if other NMH
medications and therapies are more effective in treating NMH in CFS patients
than Florinef alone.
Sleep disorders and CFS
Brugmann University Hospital in Brussels, Belgium explored whether primary sleep
disorders (PSD) and sleepiness are common in CFS patients. Patients underwent a
clinical examination and two nights of all-night monitoring during sleep. Of the
46 CFS patients studied, 54% did not have PSD and 69% had no
While 46% of the CFS patients showed signs of sleep apnea,
none were diagnosed with narcolepsy or hypersomnia. No association was found
between a sleep disorder and a patient’s clinical status.
concluded that it is unlikely CFS is a somatic expression of a primary sleep
disorder or sleepiness. The full
study is published in Sleep Research Online.
CFS genetic link studied
University of Queensland
researchers discovered a genetic mutation they believe may, in part, explain
what causes CFS. They identified the same gene mutation in 32 members of one
Australian family, all of who reportedly have CFS.
The gene regulates the
production of cortisol, a hormone released by the adrenal glands in response to
stress and which affects immune response.
Dr. David Torpy, a member of
the research team, stressed that even if the genetic mutation plays a role in
CFS it is unlikely to be the only cause. “However, if this accounts for even one
percent of chronic fatigue syndrome sufferers, then it would be a big advance,
especially if it is treatable,” he said.
The research team’s findings,
which were presented at the 11th International Congress of Endocrinology in
Sydney in October, have not yet been published.
Keep in mind that research studies with fewer than 500
patients are generally not considered statistically valid and may be questioned
by the medical community. The Chronicle reports on smaller studies due to
the lack of large-scale research projects and to keep you updated on emerging
Experts discuss research
For information on the
Association’s December research symposium on orthostatic intolerance and
CFS, see the winter 2001 issue of The CFS Research Review.