Praxisleitfaden und Off-Label-Therapie bei ME/CFS

In the first part of her presentation, Dr. Marie Witt introduced the practical guide for ME/CFS—developed by the German Association for ME/CFS in collaboration with the Charité Fatigue Center—which is structured into two sections: The first section contains basic information for the general public regarding the clinical picture, diagnostic criteria, symptoms, severity levels, and issues related to patient care. The second section—accessible via a DocCheck login—consists of specialised information for medical professionals, focusing on diagnostic procedures, tips and techniques for taking patient histories, therapeutic management, and guidance on clinical care provision. Additionally, topics such as energy management, pacing, physiotherapy, and coping strategies are explained. The guide concludes with practical instructions on medical coding and billing. In the second part of her presentation, Dr. Witt introduced three of the most frequently used off-label medications: Pyridostigmine, an acetylcholinesterase inhibitor, which can have a positive impact on fatigue, orthostatic intolerance, and post-exertional malaise (PEM) in ME/CFS patients; Low-dose Naltrexone (LDN), an opioid antagonist with a spectrum of action that may involve increased endorphin concentrations and anti-inflammatory effects, potentially alleviating fatigue and cognitive dysfunction while improving PEM; and Low-dose Aripiprazole (LDA), an atypical antipsychotic that acts as a dopamine stabiliser and exerts a positive influence on neuroinflammation, microglial activation, and cell death. Dr. Witt concluded by referencing the "Long COVID Off-Label List" recently published by the G-BA (Federal Joint Committee), highlighting the four drugs included therein: agomelatine, ivabradine, vortioxetine, and metformin. Furthermore, Dr. Witt called for additional clinical research into off-label drugs in order to generate evidence for potential therapies and thereby improve ME/CFS patient care.