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Potential disease-modifying effects of selective serotonin reuptake inhibitors in multiple sclerosis: systematic review and meta-analysis
  1. P Foley1,2,3,
  2. A Lawler1,
  3. S Chandran1,2,
  4. G Mead1
  1. 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  2. 2Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
  3. 3Department of Palliative Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr P Foley, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; peterfoley{at}nhs.net

https://doi.org/10.1136/jnnp-2013-306829

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    Introduction

    Development of further effective and well-tolerated disease-modifying therapies (DMTs) for multiple sclerosis (MS) is a major research priority. Strategies include ‘repurposing’ drugs, which are already approved for other indications, as DMTs. While selective serotonin reuptake inhibitors (SSRIs) are widely used as antidepressants, preclinical and clinical studies suggest that disease-modifying effects in relapsing and progressive MS are plausible1 (see online additional material). Furthermore, a recent Cochrane systematic review demonstrated that, in adults with stroke, SSRIs improved measures of dependence, disability and neurological impairment.2 We therefore aimed to identify, assess and synthesise randomised controlled trials (RCTs) examining effects of SSRIs on the MS disease course.

    Methods

    Methodology and reporting follows Cochrane Collaboration and PRISMA recommendations.2 We searched The Cochrane Library, MEDLINE, EMBASE, PsychINFO, CINAHL and BIOSIS (20 March 2013) (see online material for full-search strategies). We performed a cited reference search, scrutinised reference lists and contacted study authors.

    We included RCTs only of SSRIs compared with placebo or usual care in subjects with definite MS. Our primary outcome was MS disease activity (including direct or surrogate clinical or other measures of disease activity or progression). Secondary outcomes were depressive or other symptoms, quality of life and adverse events. Two authors independently extracted methodological and study data. We assessed risk of bias using Cochrane Collaboration recommendations.2 Where appropriate, we calculated event rates and event …

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    Footnotes

    • Contributors  GM designed the study. AL and PF were responsible for data acquisition. PF, AL and GM were responsible for data analysis. PF, AL, SC and GM contributed to the writing of the paper  and approved the manuscript for publication.

    • Competing interests PF gratefully acknowledges funding from the Anne Rowling Regenerative Neurology Clinic.

    • Provenance and peer review Not commissioned; externally peer reviewed.