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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV1094

Stimulant medications for fatigue in primary brain tumors and brain metastases: a scoping review of efficacy and safety

STIMULANT MEDICATIONS FOR FATIGUE IN PRIMARY BRAIN TUMORS AND BRAIN METASTASES: A SCOPING REVIEW OF EFFICACY AND SAFETY

There is no evidence supporting the use of stimulant medications for cancer-related fatigue in patients with primary brain tumors or brain metastases.

The aim of the study was to map the evidence on the efficacy, safety, and outcome measurement of psychostimulant medications for cancer-related fatigue (CRF) in patients with primary brain tumors or brain metastases. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched; of 1,062 records, 460 were removed before screening, 602 records were screened, 72 studies were assessed for eligibility, and 15 studies were included in the review (9 primary studies and 6 associated clinical trial registry records). Background data indicated a pooled prevalence of CRF in cancer populations of 43% (95% confidence interval, 39.2% to 47.2%), with moderate-to-severe fatigue reported in 52.5% and severe fatigue in 39.7% of patients with brain cancer. Randomized studies did not demonstrate superiority on the primary fatigue outcome: Porter and colleagues (2022, n=328) reported response rates with armodafinil of 28.2% (150 mg), 27.8% (250 mg), and 29.9% (placebo) (P=0.94); Laigle-Donadey and colleagues (2019, n=48 randomized, 41 analyzed) found that a 14-point improvement on the MFI-20 with dextroamphetamine was not significant compared with a 10-point improvement with placebo (P=0.17); Lee and colleagues (2016, n=81) found no FACIT-F benefit with armodafinil at day 43 (P=0.30); Butler and colleagues (2007, n=68, including 35 with brain metastases) reported an adjusted FACIT-F difference of -1.9 with d-threo-methylphenidate (95% confidence interval, -9.6 to 5.8; P=0.64). In the placebo-controlled crossover study of modafinil by Boele and colleagues (2013, n=37), fatigue improved in both arms, with no difference between conditions (P=0.456 for CIS fatigue severity); in the open-label study by Gehring and colleagues (2012, n=34 enrolled, 24 analyzed), BFI scores improved from before to after treatment (P=0.04), but there was no placebo control and no difference was observed between methylphenidate and modafinil. Safety findings were inconsistent: insomnia and discontinuation due to adverse events increased with 250 mg armodafinil, psychiatric adverse effects were more frequent with dextroamphetamine (P=0.018), and seven participants in the Boele study discontinued medication because of adverse effects. The available evidence is limited and heterogeneous, there are no efficacy data specific to brain metastases, and larger studies using standardized fatigue measures are needed.

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