Fluoxetine shows no benefit against AFM in children

  • Messacar K & al.
  • Neurology
  • 9 Nov 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Fluoxetine (Prozac) failed to improve muscle strength in children with enterovirus (EV)-D68-associated acute flaccid myelitis (AFM).

Why this matters

  • Clinicians suspecting AFM in presenting patients, especially children, should follow CDC guidance on timely specimen collection and clinical management.

Key results

  • 56 children, 12 study sites, 36% (n=20) with EV-D68-associated AFM.
  • 30 received fluoxetine a median 5 (interquartile range, 3-7) days after neurologic onset, either prenadir (37%, n=11) or postnadir (60%, n=18).
  • At baseline, fluoxetine-treated vs untreated patients had similar strength (mean summative limb strength score [SLSS], 12.9 vs 14.3; P=.31), but they had more severe paralysis at nadir (mean SLSS, 9.3 vs 12.8; P=.02) and at latest follow-up (mean SLSS, 12.5 vs 16.4; P=.005).
  • 11 fluoxetine prenadir patients had lower unadjusted mean SLSS change from initial examination to latest follow-up vs untreated patients (−2.1; 95% CI, −5.6 to 1.3).
  • Fluoxetine-treated patients had longer length of stay vs untreated patients (median, 14 vs 17 days; P=.007), and were likelier to require intensive care unit care and other supportive measures.

Study design

  • Retrospective, multicenter cohort study evaluating the safety, tolerability, and efficacy of fluoxetine for proven or presumptive EV-D68-associated AFM.
  • Funding: NIH.

Limitations

  • Observational.
  • Misclassification bias.
  • Muscle selection bias.
  • Small sample size.

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