The Pharmaceutical Journal
Vol 280 No 7501 p560
10 May 2008

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Fluoxetine could benefit patients with multiple sclerosis

Fluoxetine has a tendency to reduce the formation of new brain lesions over time in patients with multiple sclerosis (MS), preliminary research published online reveals (Journal of Neurology, Neurosurgery and Psychiatry, 1 May 2008).

In a double-blind, placebo-controlled exploratory study researchers randomly assigned 40 non-depressed patients with relapsing remitting or relapsing secondary progressive MS to fluoxetine 20mg or placebo daily for 24 weeks. MRI scans of the brain were performed at four, eight, 16 and 24 weeks.

The fluoxetine group showed a trend towards a reduction in the cumulative volume of new gadolinium-enhancing lesions, the number of scans with gadolinium-enhancing lesions and increase of lesion load. No differences in MRI outcome measures were seen up to the first eight weeks of treatment.

However, during the last 16 weeks the number of patients with no new gadolinium-enhancing lesions was 63 per cent in the fluoxetine group compared with 26 per cent in the placebo group (P=0.02).

The researchers conclude that the results are sufficiently encouraging to justify further studies with fluoxetine in patients with MS. Higher doses and combination treatment with immunomodulatory drugs should be considered. They say that an interesting aspect of considering fluoxetine as a candidate for the treatment of MS is its additional mechanisms of action, including the production of neurotrophic factors by astrocytes.

However, conclusions from the study “must be made with caution because of the small sample size and exploratory design,” they say.