NEWS

We are pleased to share our new discoveries from a research study called the “COMBO-MS” trial.

This study measured how well the following three treatments worked for fatigue in people with multiple sclerosis (MS) (N=336):
(1) a form of talk therapy called cognitive behavioral therapy (CBT)
(2) a medication known as modafinil
(3) a combination of these two treatments (COMBO)

Results
1. On average, all three treatments improved fatigue impact to a level that matters for most patients. No one treatment was better than another in improving fatigue impact or severity.


2. At least two-thirds of people in each of the treatment groups had a 10-point or greater improvement in their fatigue impact scores. That is, fatigue scores got much better as a result of treatment, for most people in all treatment groups.

People in the COMBO group (both CBT and modafinil) reported the biggest improvement in overall quality of life. 

3. Our findings show that 
(a) for people with poor sleep habits, CBT was better than modafinil for improving fatigue impact (in other words, lowering fatigue impact scores) 
b) for less disabled people, modafinil was better than CBT in improving fatigue severity (in other words, lowering fatigue severity scores)
(c) for people with more disability, all three treatments improved fatigue severity equally.

4. All three treatments were well-tolerated with no serious side effects.

5. Although rare, the most common side effects of modafinil were trouble sleeping, anxiety, and headache. Only 7% of people reported trouble sleeping, 5% reported anxiety, and 4% reported headache.

6. For those in the modafinil-only or COMBO groups, daily modafinil doses ranged from 25mg to 400mg. The most common daily dose was 100mg (half of all doses). Most (70%) people reported that they took their modafinil just once a day.

7. Telephone-delivered CBT was easy to access and use. Eighty-five percent of people in the CBT-only group and 90% in the COMBO group completed all eight sessions of therapy.

Next steps
We will write these findings for publication in journals and ads in the media. We hope that patients, doctors, nurses, insurance companies, hospitals, and researchers can learn from this study’s findings.

Research team
The study was led by Drs. Tiffany Braley and Anna Kratz at the University of Michigan and Drs. Kevin Alschuler, Dawn Ehde, and Gloria von Geldern at the University of Washington. Our team also included people with MS, MS providers, MS community leaders, and a leader from Blue Cross Blue Shield of Michigan.

Funding
The study was funded by the Patient Centered Outcomes Research Institute and the National Multiple Sclerosis Society.

It is with great sadness that we announce the passing of Dr. George Kraft on November 1, 2022. Dr. Kraft was a titan in the field of multiple sclerosis (MS) care, research, and education, an expert electro-diagnostician and a key member of our faculty for 51 years. Dr. Kraft was a remarkable scientist, clinician, mentor, and person. He will be missed.

Dr. Kraft was born in Columbus, Ohio, on September 27, 1936. He received an AB in economics from Harvard College in 1958. He then went to Ohio State University, where he earned an MD in 1963 and completed his MS and a physical medicine and rehabilitation residency in 1967.

Dr. Kraft served with the Medical Corps of the U.S. Navy from 1967 to 1969. In 1969, he began his long association with the University of Washington (UW). He first joined the Department of Rehabilitation Medicine as an assistant professor and reached the rank of professor in 1976, a position he held until 2012 when he became a professor emeritus—although he didn’t fully retire until 2020. Additionally, he held the position of adjunct professor in the Department of Neurology from 1999 to 2012 and was the inaugural Nancy and Buster Alvord Professor of Multiple Sclerosis Research from 2005 to 2015.

Among the many notable honors of his career, he received a Lifetime Achievement Award from the National Multiple Sclerosis Society in 2011, and a Distinguished Clinician Award, Walter J. Zeiter Award and Frank H. Krusen Award from the American Academy of Physical Medicine & Rehabilitation. He also received the Distinguished Academician Award from the Association of Academic Physiatrists. He has the remarkable achievement of having served as the President of the American Academy of Physical Medicine & Rehabilitation, the Association of Academic Physiatrists, the American Association of Neuromuscular and Electrodiagnostic Medicine, and as Chair of the American Board of Electrodiagnostic Medicine.

Throughout his long career, Dr. Kraft made significant contributions as an educator and a clinician. He received many citations as a top physician and was recognized by his colleagues and trainees as an exceptional mentor to the next generation of clinicians and psychologists with an interest in MS. As well, he filled important roles on local, national, and international committees. While his career had many aspects, Dr. Kraft will be best remembered for his tremendous achievements in MS care. His seminal achievements in MS research have changed our understanding of the disease and transformed care for people with MS.

In the late 1970s, when there were very few if any, dedicated MS centers across the U.S., Dr. Kraft helped organize the first multi-disciplinary MS Center as a joint venture between the departments of rehabilitation medicine and neurology at the UW. At the time, his insight into the necessity for interdisciplinary care for MS was new. Today, the National Multiple Sclerosis Society only certifies comprehensive centers that combine rehabilitation, neurology, and mental health care according to the model first developed by Dr. Kraft. In 1982, he became director of the UW MS Center. Under his leadership, the Center made tremendous strides in both understanding MS and improving the care and treatment of people with the disease.

Dr. Kraft made a multidisciplinary approach central to the care of patients with MS. He also was also the first to illustrate empirically that fatigue was the most common and, for many, one of the most disabling symptoms of MS. Today, fatigue is accepted as a core clinical measure for MS. Dr. Kraft was also one of the first to recognize and write about the way the many symptoms of MS synergistically impact patients.

Dr. Kraft’s prolific research was always rooted in care and concern for his patients. He was noted for his empathy, and his ability to truly listen to his patients. Not only did he maintain a patient focus in his own research, but he also helped transform the culture of MS research through the establishment of the UW MS Rehabilitation Research and Training Center, which conducts patient-centered research. The hundreds of studies conducted through the Center have changed our understanding of MS and how to best care for patients to maximize functioning and quality of life. As a mentor and educator, Dr. Kraft tirelessly supported trainees and has been formative in the careers of many junior faculty. With his mentorship and guidance, they successfully established thriving careers.

Throughout his life, Dr. Kraft had a tremendous impact on MS research and health care, and his influence will continue for decades to come. Thanks to his tireless vision, advocacy, and empathy, the care and treatment of people with MS have forever changed.