"There were trends in favor of fluoxetine for cumulative volume of new Gd-enhancing lesions (median, 77 vs 22 mm3; P =.16), change in T2 lesion load (median, 475 vs 128; P =.10), and scans showing Gd-enhancing lesions (33 vs 22; P =.06). Significant benefit for fluoxetine was reached for scans showing new Gd-enhancing lesions (31 vs 19; P =.04).
"It is interesting to note that it takes several weeks for plasma levels of fluoxetine to stabilize," Dr. Mostert said. This was seen on reanalysis of the last 16 weeks (2 scans) of the secondary outcome trends. Here, the cumulative number of new Gd-enhancing lesions almost reached significance (3.16 vs 1.21; P =.05), and significance was reached for both the number of patients with no new Gd-enhancing lesions (5 vs 12; P =.02) and the scans showing Gd-enhancing lesions (18 vs 9; P =.0).
Thus, while indicating that their small sample size was the main limitation of the study, Dr. Mostert noted the good tolerability of fluoxetine, the beneficial trends associated with its use, and the delay in their significance that matched with the known delay in stabilization of fluoxetine plasma levels.
In considering in particular the characteristics of fluoxetine as an oral agent that is affordable, well tolerated, and not known to have any long-term adverse effects, Dr. Mostert indicated that further studies on this agent are justified.