AHMF: Conf 2001: RCW Vermeulen

Carnitine, Acetylcarnitine and Propionylcarnitine in the Treatment of Chronic Fatigue Syndrome

RCW Vermeulen*, RM Kurk*, HR Scholte**

*CFS Research Center Amsterdam,
Amsterdam,
The Netherlands

**Erasmus University Rotterdam,
Rotterdam,
The Netherlands

CFS Research Center Amsterdam,
Waalstraat 25, 1078 BR
Amsterdam,
The Netherlands

Tel: +31 204706290
Fax: +31 204706299
Email: rcwvermeulen@intermedclin.com

We treated 150 patients with complaints of Chronic Fatigue Syndrome (CFS, CDC 1994 criteria) in an open label study with 1g oral L-carnitine bid. After 6 months 104 patients (69%) reported improvement of symptoms of fatigue, cognition and/or pain.

Another 18 CSF-patients were included in a randomised double blind study. Six were treated with oral acetyl-L-carnitine 1g/d plus L-carnitine 1g/d, 6 received twice the dosage and 6 placebo. After 6 months major improvement was reported by 4 patients in the low dosage group, none in the high dosage group and 1 in the placebo group.

We included 90 CFS-patients in an open study of acetyl-L-carnitine 1g bid, propionyl-L-carnitine 1g bid or both. The endpoints of the study were the Clinical Global Impression (CGI), fatigue score (MFI-20), cognition (Stroop) and pain (MPQ-DLV). At screening, patients complaints and cognitive performance were assessed. This was repeated after 2 months no-treatment period, then patients were randomly distributed in 3 groups and treated for 6 months. Two weeks after the last visit in the treatment period, patients were seen for follow up.

In the no-treatment period 15% improved (CGI). After treatment for 6 months 61% improved in the single, low dosage groups and 36% in the double, high dosage group (p= 0.05). The improvement after 6 months was significant in all groups for the CGI, the fatigue score and the Stroop test (p<0.05).

Plasma free-carnitine levels at randomisation correlated positively with clinical improvement (DCGI, p=0.013; D fatigue-score, p=0.008).

At follow up, 52% of patients in the low dose and 41% in the high dose group had a relapse of CFS.

These studies indicate that L-carnitine, acetyl-L-carnitine and propionyl-L-carnitine are successful for the treatment of symptoms of chronic fatigue syndrome in a major subset of patients.