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. 2021 Mar 22:12:633781.
doi: 10.3389/fneur.2021.633781. eCollection 2021.

Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

Guangjie Liu  1 , Xingyu Yang  1 , Tao Xue  1 , Shujun Chen  2 , Xin Wu  1 , Zeya Yan  1 , Zilan Wang  1 , Da Wu  3 , Zhouqing Chen  1 , Zhong Wang  1
Affiliations

Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

Guangjie Liu et al. Front Neurol. .

Abstract

Background and Purpose: Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive-compulsive disorder, and some studies have shown that fluoxetine can improve motor and function recovery after stroke. Therefore, we performed a meta-analysis to investigate the efficacy and safety of fluoxetine in the treatment of post-stroke neurological recovery. Methods: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) that were performed to assess the efficacy and safety of fluoxetine for functional and motor recovery in subacute stroke patients up to October 2020. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) and standardized mean difference (SMD) were analyzed and calculated with a fixed effects model. Results: We pooled 6,788 patients from nine RCTs. The primary endpoint was modified Rankin Scale (mRS). Fluoxetine did not change the proportion of mRS ≤ 2 (P = 0.47). The secondary endpoints were Fugl-Meyer Motor Scale (FMMS), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS). Fluoxetine improved the FMMS (P < 0.00001) and BI(P < 0.0001) and showed a tendency of improving NIHSS (P = 0.08). In addition, we found that fluoxetine reduced the rate of new-onset depression (P < 0.0001) and new antidepressants (P < 0.0001). Conclusion: In post-stroke treatment, fluoxetine did not improve participants' mRS and NIHSS but improved FMMS and BI. This difference could result from heterogeneities between the trials: different treatment duration, clinical scales sensitivity, patient age, delay of inclusion, and severity of the deficit.

Keywords: MRS; fluoxetine; meta-analysis; recovery; rehabilitation; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The study search, selection, and inclusion process.
Figure 2
Figure 2
The pooled RR or SMD of primary outcomes and secondary outcomes. The blue square indicates the estimated RR. The green square indicates the estimated SMD. The size of blue square indicates the estimated weight of each RCT, and the extending lines indicate the estimated 95% CI of RR for each RCT. The black diamond indicates the estimated RR (95% CI) for all patients together. (A) Modified Rankin Scale (mRS; 0–2). (B) Fugl-Meyer Motor Scale (FMMS). (C) Barthel Index (BI). (D) National Institutes of Health Stroke Scale (NIHSS). RR, risk ratio; SMD, standardized mean difference; RCT, randomized controlled trial; CI, confidence interval.
Figure 3
Figure 3
Risk of bias: a summary table for each risk of bias item for each study.
See this image and copyright information in PMC

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