A Cochrane review [Abstract] 1 included 27 studies with a total of 6 746 subjects. The drugs were analysed by class (psychostimulants; haemopoetic growth factors; antidepressants and progestational steroids). Methylphenidate showed a small but significant improvement in fatigue over placebo in the active treatment of any tumor type with follow-up time up to 8 weeks (2 trials, 264 participants; Z score = 2.40; SMD -0.30, 95% CI -0.54 to -0.05). Erythropoietin showed a small but significant improvement in fatigue for anaemic patients receiving chemotherapy compared to placebo (10 trials, 3735 participants; overall effect Z score = 8.32 (P < 0.001), SMD -0.30, 95% CI -0.46 to -0.29.). Darbopoietin also demonstrated a smaller but significant improvement in fatigue over placebo (4 trials, 1650 participants; overall effect Z score = 1.45 (P = 0.05) , SMD -0.13, 95% CI -0.27 to 0.00). All erythropoetin and darbopoetin trials had a minimum of 12 weeks follow up with some of up to 18 weeks. Paroxetine (2 trials 645 participants) and progestational steroids (4 trials 587 participants) demonstrated no superiority over placebo in treating CRF.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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