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【摘錄自Chataway,DAngelisFConcPtal.Lancet Neurol. 2020 Mar; 19(3) :214-225.】
Background: Neurodegeneration is the pathological substrate that causes major disability in
secondary progressive multiple sclerosis. A synthesis of preclinical and clinical research
identified three neuroprotective drugs acting on different axonal pathobiologies. We aimed to
test the efficacy of these drugs in an efficient manner with respect to time, cost, and patient
resource.
Methods: We did a phase 2b, multiarm, parallel group, double-blind, randomised
placebo-controlled trial at 13 clinical neuroscience centres in the UK. We recruited patients
(aged 25-65 years) with secondary progressive multiple sclerosis who were not on
disease-modifying treatment and who had an Expanded Disability Status Scale (EDSS) score
of 4 0-6:5. Participants were randomly assigned (1:1:1:1) at baseline, by a research nurse using
a centralised web-based service, to receive twice-daily oral treatment of either amiloride 5 mg,
fluoxetine 20 mg, riluzole 50 mg, or placebo for 96 weeks. The randomisation procedure
included minimisation based on sex, age, EDSS score at randomisation, and trial site. Capsules
were identical in appearance to achieve masking. Patients, investigators, and MRI readers were
unaware of treatment allocation. The primary outcome measure was volumetric MRI
percentage brain volume change (PBVC) from baseline to 96 weeks, analysed using multiple
regression, adjusting for baseline normalised brain volume and minimisation criteria. The
primary analysis was a complete-case analysis based on the intention-to-treat population (all
patients with data at week 96). This trial is registered with Clinical Trials.gov, NCT0 1910259.
Findings: Between Jan 29, 2015, and June 22, 2016, 445 patients were randomly allocated
amiloride (n=111), fluoxetine (n=111), riluzole (n=111), or placebo (n=112). The primary
analysis included 393 patients who were allocated amiloride (n=99), fluoxetine (n=96), riluzole
(n=99), and placebo (n=99). No difference was noted between any active treatment and
placebo in PBVC (amiloride vs placebo, 0.0% [95% CI -0ㆍ4 to 0ㆍ5; p-0.99]; fluoxetine vs
placebo -0ㆍ1% [-0'5 to 0 3; p=0-86]; riluzole vs placebo -0ㆍ1% [-0ㆍ6 to 0:3; p-0.77). No
emergent safety issues were reported. The incidence of serious adverse events was low and
similar across study groups (ten [9%] patients in the amiloride group, seven [6%] in the
fluoxetine group, 12 [11%] in the riluzole group, and 13 [12%] in the placebo group). The
most common serious adverse events were infections and infestations. Three patients died
during the study, from causes judged unrelated to active treatment; one patient assigned
amiloride died from metastatic lung cancer, one patient assigned riluzole died from ischaemic
heart disease and coronary artery thrombosis, and one patient assigned fluoxetine had a sudden
death (primary cause) with multiple sclerosis and obesity listed as secondary causes.
【題組】(1-1)請說明本研究設計。(5%)