Key takeaways:
- Survival charges of these on riluzole have been just like charges of sufferers with different neuromuscular circumstances.
- The outcomes assist additional testing of medicines that suppress REM sleep in sufferers with ALS.
REM sleep-suppressing antidepressants have been linked to increased chance of 2-year survival in ALS, in line with a speaker on the American Thoracic Society Worldwide Convention.
“This analysis aimed to supply final result knowledge for ALS sufferers prescribed REM suppressing antidepressants, versus these which don’t suppress REM,” Cosmo Fowler, MD, sleep medication fellow at Emory College Faculty of Drugs, informed Healio.
Knowledge have been derived from Fowler C, et al. Speedy eye motion sleep-suppressing antidepressant use is related to enhanced survival in amyotrophic lateral sclerosis. Offered at: American Thoracic Society Worldwide Convention; Might 16-21, 2025; San Francisco.
“This was as a result of there was (small pattern however potential) knowledge pointing to REM suppressing antidepressants enhancing nocturnal hypoxia in Duchenne muscular dystrophy, particularly protriptyline,” he continued.
Throughout REM sleep, a state of paralysis inside the physique poses a risk to the well being of people with neuromuscular circumstances whose signs embody weakened diaphragms, in line with an ATS launch associated to the examine.
As such, Fowler and colleagues carried out a retrospective cohort examine analyzing sufferers with ALS in america. They utilized the TriNetX Analysis community digital well being report aggregator in addition to claims-derived knowledge of greater than 132 million sufferers to establish 17,444 people identified with ALS and prescribed riluzole between September 2003 and September 2023.
“We required ALS encounter diagnoses be accompanied by riluzole prescription to boost diagnostic specificity,” Fowler mentioned. Eligible sufferers have been subsequently cut up into an REM-inhibited cohort (n = 2,492) of these prescribed certainly one of greater than 25 antidepressant medicines linked to suppression of REM sleep within the 3 years previous inclusion standards, in addition to a non-REM-inhibited cohort (n = 365) who acquired antidepressants not linked to REM suppression.
Probably the most represented within the REM-suppressed cohort have been selective serotonin reuptake inhibitors together with sertraline, escitalopram, citalopram, fluoxetine, and paroxetine, in addition to tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Cosmo Fowler
Within the non-REM-suppressed cohort, essentially the most represented have been trazodone, mirtazapine, and bupropion, Fowler informed Healio.
The examine’s major final result was 2-year survival, analyzed utilizing Kaplan-Meier methodology together with hazard ratios estimated with Cox proportional hazards fashions. Propensity rating matching was carried out utilizing age, race and gender.
Based on outcomes, Kaplan-Meier survival charges at 2 years have been considerably increased within the REM-inhibited group in contrast with non-inhibited (47.18% vs. 41.06%) previous to propensity rating matching, with a hazard ratio of 1.21 (95% CI: 1.022-1.433).
After matching, Fowler and colleagues reported the survival pattern was constant however not important (48.13% vs. 41.06%; HR = 1.23; 95% CI: 0.981-1.547). They added that this proportionality urged a constant therapy impact by means of a follow-up interval.
“This retrospective knowledge factors to a attainable therapeutic goal in ALS, a situation with comparatively few therapeutic targets, and invitations the possible testing of REM-suppressing antidepressants on this inhabitants,” Fowler informed Healio.
Reference:
Medicines that suppress REM sleep enhance survival in ALS sufferers. https://www.newswise.com/articles/medications-that-suppress-rem-sleep-improve-survival-in-als-patients/?sc=sphr&xy=10017347. Revealed Might 8, 2025. Accessed Might 20, 2025.
For extra info:
Cosmo Fowler, MD, may be reached at cosmo.fowler2@emory.edu.
