Efficacy of Fluoxetine, Riluzole and Amiloride in treating neuropathic pain associated with secondary progressive multiple sclerosis. Pre-specified analysis of the MS-SMART double-blind randomised placebo-controlled trial

Peter Foley*, Richard A Parker, Floriana De Angelis, Peter Connick, Siddharthan Chandran, Carolyn Young, Christopher J Weir, Jeremy Chataway

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Evidence-based treatment of pain in people with MS presents a major unmet need.

Objective
We aimed to establish if use of Fluoxetine, Riluzole or Amiloride improved neuropathic pain outcomes in comparison to placebo, in adults with secondary progressive MS participating in a trial of these putative neuroprotectants.

Methods
In pre-specified secondary analyses of the MS SMART phase-2b double-blind randomised controlled trial (NCT01910259), we analyzed reports of neuropathic pain, overall pain, and pain interference. Multivariate analyses included adjustment for baseline pain severity. Additionally, we explored associations of pain severity with clinical and MRI brain imaging variables.

Results
445 Participants were recruited from 13 UK neuroscience centres. We found no statistically significant benefit of active intervention on any rating of neuropathic pain, or pain overall. Compared to placebo, adjusted mean difference in pain intensity was 0.38 (positive values favouring placebo, 95%CI -0.30 to 1.07, p = 0.27) for Amiloride; 0.52 (-0.17 to 1.22, p = 0.14) for Fluoxetine; and 0.40 (-0.30 to 1.10, p = 0.26) for Riluzole. Pain severity was positively correlated with depressive symptoms (Spearman correlation 0.19, 95%CI 0.10–0.28) and fatigue (Rho 0.30, 95%CI 0.20–0.39).

Conclusion
Use of Fluoxetine, Riluzole or Amiloride was not associated with improvement in neuropathic pain symptoms, in comparison to placebo.
Original languageEnglish
Article number103925
JournalMultiple Sclerosis and Related Disorders
Volume63
DOIs
Publication statusPublished - 28 May 2022

Keywords / Materials (for Non-textual outputs)

  • Analgesia
  • Multiple sclerosis
  • Neuropathic pain
  • Pain
  • Randomized controlled trial
  • Secondary progressive multiple sclerosis
  • Serotonin uptake inhibitor

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