The following article is part of conference coverage from the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event. Neurology Advisor‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. .
Individuals with relapsing-remitting multiple sclerosis (MS) who respond suboptimally to disease-modifying therapy (DMT) may experience an improved response with the addition of a selective serotonin-reuptake inhibitor (SSRI) of duloxetine or fluoxetine, according to study results presented at the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event, held September 11-13, 2020.
One of the most common hurdles in clinical treatment of MS is suboptimal response for first-line treatment of the disease. The goal of this study was to determine the potential of SSRI use to optimize response rate for such patients who respond suboptimally on first-line injectable DMT.
This study included 70 individuals (56 women; average age, 35.2 years) with relapsing-remitting MS. The average duration of disease among the study patients was 4.2 years. Inclusion criteria for participants included having relapsing-remitting MS, mild to moderate depression, and suboptimal response to treatment with either interferon beta or glatiramer acetate in the last year (defined by 1 relapse without MRI activity or MRI showing 4-6 more T2 lesions in the previous year). Those with progressive MS, nonresponse to first-line therapy, severe depression, or severe comorbidity were excluded from the study.
During the baseline visit, study researchers determined participants’ expanded disability status scale (EDSS) score (3.0) and dynamics in the previous year (+0.27; 95% CI, 0.24-0.31), T2 lesion load in the previous year (+3.57 lesions; 95% CI, 2.6-4.8), relapse rate in the previous year (0.65; 95% CI, 0.61-0.70), and depression. Participants also began duloxetine or fluoxetine at this visit. After 1 year of DMT and SSRI, they then completed another visit and the same variables were again measured.
At the second visit (1-year mark), participants on the combination of DMT and SSRI had a significantly lower relapse rate (0.2; T=180; P <.001), no significant EDSS level increase (-0.36 points), and a significantly lower rate of new or newly enlarging T2 lesions than in the previous year (+0.4; 95% CI, 0.3-0.5; T=51; P <.001).
The study researchers concluded that “adding SSRI (duloxetine or fluoxetine) to standard first-line DMT for patients with suboptimal response could improve the response to the main DMT without switching to 2nd line.”
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Kasatkin D, Molchanova S, Stepanov I. Selective serotonin-reuptake inhibitors as potential add-on agents in relapsing-remitting multiple sclerosis patients with suboptimal response. Presented at: 8th Joint American Committee for Treatment and Research in Multiple Sclerosis and European Committee for Treatment and Research in Multiple Sclerosis MSVirtual2020 event; September 11-13, 2020. Abstract P0492.