Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study

Ruud P. H. Raijmakers, Stephan P. Keijmel, Evi M. C. Breukers, Gijs Bleijenberg, Jos W. M. van der Meer, Chantal P. Bleeker-Rovers, Hans Knoop

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial. Methods: All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity. Results: Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2–42.9] and 31.3 [95% CI, 27.5–35.1], mean difference 8.2 [95% CI, 4.9–11.6]; P <.001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1–43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5–44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6–40.7]; P =.92 and P =.38, respectively). Conclusion: The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.
LanguageEnglish
Pages62-67
JournalJournal of Psychosomatic Research
Volume116
DOIs
StatePublished - 2019

Cite this

Raijmakers, R. P. H., Keijmel, S. P., Breukers, E. M. C., Bleijenberg, G., van der Meer, J. W. M., Bleeker-Rovers, C. P., & Knoop, H. (2019). Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study. Journal of Psychosomatic Research, 116, 62-67. DOI: 10.1016/j.jpsychores.2018.11.007
Raijmakers, Ruud P. H. ; Keijmel, Stephan P. ; Breukers, Evi M. C. ; Bleijenberg, Gijs ; van der Meer, Jos W. M. ; Bleeker-Rovers, Chantal P. ; Knoop, Hans. / Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study. In: Journal of Psychosomatic Research. 2019 ; Vol. 116. pp. 62-67
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title = "Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study",
abstract = "Background: Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial. Methods: All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity. Results: Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95{\%} CI, 36.2–42.9] and 31.3 [95{\%} CI, 27.5–35.1], mean difference 8.2 [95{\%} CI, 4.9–11.6]; P <.001). Fatigue severity scores of CBT (adjusted mean 39.8 [95{\%} CI, 36.1–43.4]) and doxycycline (adjusted mean 41.0 [95{\%} CI, 37.5–44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95{\%} CI, 33.6–40.7]; P =.92 and P =.38, respectively). Conclusion: The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.",
author = "Raijmakers, {Ruud P. H.} and Keijmel, {Stephan P.} and Breukers, {Evi M. C.} and Gijs Bleijenberg and {van der Meer}, {Jos W. M.} and Bleeker-Rovers, {Chantal P.} and Hans Knoop",
year = "2019",
doi = "10.1016/j.jpsychores.2018.11.007",
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Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study. / Raijmakers, Ruud P. H.; Keijmel, Stephan P.; Breukers, Evi M. C.; Bleijenberg, Gijs; van der Meer, Jos W. M.; Bleeker-Rovers, Chantal P.; Knoop, Hans.

In: Journal of Psychosomatic Research, Vol. 116, 2019, p. 62-67.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study

AU - Raijmakers,Ruud P. H.

AU - Keijmel,Stephan P.

AU - Breukers,Evi M. C.

AU - Bleijenberg,Gijs

AU - van der Meer,Jos W. M.

AU - Bleeker-Rovers,Chantal P.

AU - Knoop,Hans

PY - 2019

Y1 - 2019

N2 - Background: Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial. Methods: All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity. Results: Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2–42.9] and 31.3 [95% CI, 27.5–35.1], mean difference 8.2 [95% CI, 4.9–11.6]; P <.001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1–43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5–44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6–40.7]; P =.92 and P =.38, respectively). Conclusion: The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.

AB - Background: Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial. Methods: All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity. Results: Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2–42.9] and 31.3 [95% CI, 27.5–35.1], mean difference 8.2 [95% CI, 4.9–11.6]; P <.001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1–43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5–44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6–40.7]; P =.92 and P =.38, respectively). Conclusion: The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.

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U2 - 10.1016/j.jpsychores.2018.11.007

DO - 10.1016/j.jpsychores.2018.11.007

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JO - Journal of Psychosomatic Research

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JF - Journal of Psychosomatic Research

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