The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) held its annual conference in Barcelona on September 24, 2025 through September 26, 2025, at the CCIB Barcelona International Convention Center, where experts, clinicians, and researchers from around the world convened to share insights and learn.
Fatigue remains one of the most commonly reported symptoms among the multiple sclerosis population, making it a hot topic at the annual conference. Not only does fatigue affect the patient’s health-related quality of life, but it also contributes to depression, anxiety, and social participation. While these fatigue-related consequences are commonly known and documented in the literature, the relationship between fatigue and MS remains understudied.
Researchers investigated the correlation between MS and fatigue, displaying the group’s findings during Poster Session 1, titled Clinical Aspects of MS – Symptoms (Cognition, Fatigue & Co) during the conference (POSTER ID -030). Young and her colleagues’ poster, titled Fatigue in Multiple Sclerosis: Prevalence, Associated Symptoms, and Trajectories over 42 Months.
The study had three key objectives: to explore (1) the prevalence of fatigue in a large longitudinal cohort with patients with multiple sclerosis (pwMS), (2) the association between fatigue and other symptoms, and (3) various fatigue trajectories as a function of time.
Investigators recruited patients throughout the UK as part of the multi-center UK Trajectories of Outcomes in Neurological Conditions (TONiC) study. The study followed 6,356 adults, the overwhelming majority of whom were female (74.1%) and 25.9% of whom were male. The study included adults who had MS regardless of the degree of disability, provided the participants were able to grant informed consent and complete a questionnaire with or without the assistance of a scribe.
Researchers collected eight different patient-reported outcome measures. These were fatigue – neurological fatigue index, spasticity-related pain, bladder complications, anxiety, cognitive function, non-restorative sleep, physical function, and visual problems. Among the 4342 patients who completed the study, the median level of fatigue on the Neurological Fatigue Index-MS (metric) was 18.2 (IQR: 14.5- 23.0); only 1.5% scored zero, and 6.1% scored the maximum. There was a statistically significant difference in fatigue across the different MS subgroups with the results as follows: a metric average score of 17.4 for relapsing (RR), 19.5 for primary progressive, and 21.0 for secondary progressive (SP) (F 112.8 (df2, 4393); p£0.001). The effect size of the difference in fatigue between RR and SP was 0.54, considered medium, indicating that the statistical difference was meaningful, not just driven by sample size.
With a mean disease duration of 11.2 years (SD 9.8%), approximately two-thirds of the patients followed had relapsing remitting MS (66.9%), followed by secondary progressive (22.0%), and primary progressive MS (11.1%). More than half of all participants (59%) had at least 1 comorbidity, while 55.6% of them had relapsing remitting MS and progressive MS (79.8%).
The study’s findings ultimately gave researchers additional clarity regarding fatigue. A common symptom in pwMS, fatigue manifests in delineated subgroups and varies in association with functioning and symptomatology. In addition, the data showed an association between some treatable factors that could improve or worsen fatigue. The study’s authors surmised that future research should evaluate the clinical benefits of screening for and treating pwMS in patients at risk for worsening fatigue.
Frieda Wiley, PharmD has no conflicts of interest to report.
Illustration by April Brust
