Treatment advances

D.Strayer (Philadelphia, USA) gave an update on the use of Rintatolimod (previously known as Ampligen). They had studied the use of the drug in XMRV/pMRV antibody positive patients. Of the patients selected, 33.7% were antibody positive. The antibody negative group had lower activity for daily living scores. Those who were antibody-positive showed a significantly greater increase in exercise treadmill tolerance when treated with the drug than those treated with placebo and those who were antibody negative. The responding patients also showed a decrease in use of other medication.

The use of Rifampicin was found to augment the effects of oxymatrine (Equilibrant) in ME/CFS patients by J.Chia (Torrance, USA). Those with chronic enterovirus infection had previously been shown to benefit from oxymatrine (Equilibrant). 46 ME/CFS patients were treated with Rifampicin 300mg bd for 7 days while taking oxymatrine and compared with patients taking just oxymatrine, and a control group. Initially flu-like symptoms occurred in those taking the rifampicin plus oxymatrine, but subsequent symptomatic improvement was observed in 60%.  Short courses of rifampicin may therefore be beneficial in oxymatrine responders. Rifampicin induces nitric oxide from human aveolar macrophages causing the initial flu-like symptoms. 2nd or longer courses of rifampicin did not appear to help.

F.Friedberg (Stonybrook, NY) tested a brief self-management protocol for unexplained chronic fatigue and ME/CFS in primary care. Two self-management sessions focussing on CBT were undertaken in 3 study conditions: 1) standard medical care alone, 2) standard medical care plus nurse-delivered attention control condition of symptom monitoring and 3) standard medical care plus nurse-delivered self-management CBT. There was modest improvement in fatigue severity and patient global impression of change (PGIC) ratings in the self-management programme. Ratings tended to reflect different attitudes to the illness and/or differential exposures to negative major life events. Improved patients reported increased awareness of behaviour and affirmative steps to pursue more healthy activities. Self-management can generate improved outcomes.