Real-world evidence of riluzole on survival and ALSFRS change in a Chinese ALS cohort

This study aimed to evaluate the effects of riluzole on survival and changes in ALS Functional Rating Scale (ALSFRS) among Chinese patients with Amyotrophic Lateral Sclerosis (ALS). Propensity score matching was used to balance baseline variables between the riluzole group (<i>n</i> = 238) and control group (<i>n</i> = 454). Survival was analyzed using Kaplan – Meier curves and Cox regression, while multivariable linear regression assessed ALSFRS changes at 6 and 12 months. Subgroup analyses were conducted to identify potential responders. Riluzole did not significantly improve survival (<i>p</i> = 0.478) or ALSFRS changes at 6 months (<i>p</i> = 0.380) or 12 months (<i>p</i> = 0.175). Subgroup analyses revealed no survival benefit in any subgroup, and further stratification showed inconsistent adverse effects on ALSFRS scores. Riluzole neither prolonged survival nor slowed functional decline in Chinese ALS patients, with no subgroup demonstrating a better response.