title: Association between the use of selective serotonin reuptake inhibitors and multiple sclerosis disability progression.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Kingwell
authors.affiliation: 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.
authors.forename: Hilda Ji
authors.initials: HJ
authors.lastname: De Jong
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Yinshan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Carruthers
authors.affiliation: Department of Statistics, University of British Columbia, Vancouver, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Petkau
authors.affiliation: Department of Statistics, University of British Columbia, Vancouver, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Gustafson
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Oger
authors.affiliation: Department of Medicine, Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver, Canada. helen.tremlett@ubc.ca.
authors.forename: Helen
authors.initials: H
authors.lastname: Tremlett
mesh_terms: D000328:Adult; D001955:British Columbia; D016022:Case-Control Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology; D020528:Multiple Sclerosis, Chronic Progressive / Q000453:epidemiology* / Q000503:physiopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: SSRIs; disability progression; effectiveness; multiple sclerosis; pharmacoepidemiology; population-based data