Zhang Tingting, Kingwell Elaine, De Jong Hilda Ji, Zhu Feng, Zhao Yinshan, Carruthers Robert, Petkau John, Gustafson Paul, Oger Joel, Tremlett Helen
Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
Pharmacoepidemiol Drug Saf. 2016 Oct;25(10):1150-1159. doi: 10.1002/pds.4031. Epub 2016 May 23.
Benefits of selective serotonin reuptake inhibitors (SSRIs) in modifying the multiple sclerosis (MS) disease course have been suggested, but their ability to delay disability progression remains unknown. We examined the association between SSRI exposure and MS disability progression.
A nested case-control study was conducted using the British Columbia (Canada) Multiple Sclerosis clinical data linked to health administrative data. The primary outcome was a sustained score of 6 (requires a cane to walk) on the Expanded Disability Status Scale (EDSS), and the secondary outcome was the onset of secondary progressive MS (SPMS, an advanced stage of MS). The cases were those who reached a study outcome and were matched with up to four randomly selected controls by sex, age, EDSS and calendar year at study entry using incidence density sampling. The associations between disability worsening and SSRI exposure were assessed with conditional logistic regression models, adjusted for confounders.
A total of 3920 patients were included in the main analyses, of which 272 reached sustained EDSS 6 and 187 reached SPMS. SSRI exposure was significantly different between patients who reached sustained EDSS 6 and controls [adjusted odds ratio (adjOR):1.44; 95% confidence interval (CI):1.03-2.01]. However, SSRI exposure was not significantly different between those who reached SPMS and their controls (adjOR:1.35; 95%CI:0.89-2.04).
We found no evidence to suggest that SSRI exposure was associated with a delay in MS disability accumulation or progression. Copyright © 2016 John Wiley & Sons, Ltd.
有研究表明选择性5-羟色胺再摄取抑制剂（SSRIs）在改变多发性硬化症（MS）病程方面具有益处，但其延缓残疾进展的能力尚不清楚。我们研究了使用SSRIs与MS残疾进展之间的关联。
采用与卫生管理数据相链接的加拿大不列颠哥伦比亚省MS临床数据进行巢式病例对照研究。主要结局是扩展残疾状态量表（EDSS）持续评分为6分（行走需要手杖），次要结局是继发进展型MS（SPMS，MS的晚期阶段）的发病。病例为达到研究结局的患者，并在研究入组时采用发病密度抽样，按性别、年龄、EDSS和日历年份与最多4名随机选择的对照进行匹配。使用条件逻辑回归模型评估残疾恶化与SSRIs暴露之间的关联，并对混杂因素进行校正。
主要分析共纳入3920例患者，其中272例达到EDSS持续评分为6分，187例达到SPMS。达到EDSS持续评分为6分的患者与对照之间的SSRIs暴露存在显著差异[校正比值比（adjOR）：1.44；95%置信区间（CI）：1.03 - 2.01]。然而，达到SPMS的患者与其对照之间的SSRIs暴露无显著差异（adjOR：1.35；95%CI：0.89 - 2.04）。
我们没有发现证据表明使用SSRIs与MS残疾累积或进展延迟有关。版权所有© 2016约翰威立父子有限公司。
