Table_1_The Efficacy and Tolerability of Selective Serotonin Reuptake Inhibitors for Motor Recovery in Non-depressed Patients After Acute Stroke: A Meta-Analysis.DOCX

Objective: To explore the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for motor recovery in non-depressed patients after acute stroke.
Methods: According to the predefined retrieval strategy, multiple electronic databases were searched for randomized controlled trials (RCTs) that met the inclusion criteria. The primary efficacy outcome was measured by Fugl-Meyer Motor Scale (FMMS) score and the indicators of tolerability included withdrawal rate and the incidence of adverse events (AEs).
Results: 10RCTs were included, the pooled analyses showed patients who received fluoxetine (endpoint: MD = 21.17, 95% CI 14.13–28.21, P < 0.00001; mean change: MD = 16.27, 95% CI 10.05–22.50, P < 0.00001) and citalopram (endpoint: MD = 22.93, 95% CI 11.13–34.73, P = 0.0001; mean change: MD = 24.06, 95% CI 10.47–37.65, P = 0.0005) experienced greater improvement in FMMS score. There was no evident difference in total withdrawal rate (fluoxetine: OR = 1.11, 95% CI 0.90–1.27, P = 1.38; citalopram: OR = 0.94, 95% CI 0.69–1.28, P = 0.71; escitalopram: OR = 0.87, 95% CI 0.58–1.28, P = 0.47) between two groups. Besides, the incidence of hyponatremia (OR = 2.01, 95% CI 1.16–3.50, P = 0.01), seizure (OR = 1.46, 95% CI 1.03–2.08, P = 0.04) and fracture (OR = 2.34, 95% CI 1.61–3.40, P < 0.00001) in the fluoxetine group was higher than in the placebo group.
Conclusions: Fluoxetine and citalopram can promote motor recovery in non-depressed patients with acute stroke, but it is necessary to pay attention to the possible AEs of fluoxetine, such as hyponatremia, seizure and fracture.
Systematic Review Registration: PROSPERO, identifier [CRD42021227452].

研究目的：探讨选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors，SSRIs）对急性卒中后非抑郁患者运动功能恢复的疗效与耐受性。
研究方法：按照预设的检索策略，检索多个电子数据库中符合纳入标准的随机对照试验（randomized controlled trials，RCTs）。本研究的主要疗效结局指标采用Fugl-Meyer运动功能量表（Fugl-Meyer Motor Scale，FMMS）评分进行评估，耐受性指标包括退出率与不良事件（adverse events，AEs）发生率。
研究结果：最终纳入10项随机对照试验。合并分析结果显示，接受氟西汀（终点评估：均差MD=21.17，95%置信区间CI：14.13~28.21，P<0.00001；平均变化量：均差MD=16.27，95%CI：10.05~22.50，P<0.00001）与西酞普兰（终点评估：MD=22.93，95%CI：11.13~34.73，P=0.0001；平均变化量：MD=24.06，95%CI：10.47~37.65，P=0.0005）的患者，其FMMS评分提升更为显著。两组总退出率无明显统计学差异（氟西汀组：比值比OR=1.11，95%CI：0.90~1.27，P=1.38；西酞普兰组：OR=0.94，95%CI：0.69~1.28，P=0.71；艾司西酞普兰组：OR=0.87，95%CI：0.58~1.28，P=0.47）。此外，氟西汀组低钠血症（OR=2.01，95%CI：1.16~3.50，P=0.01）、癫痫发作（OR=1.46，95%CI：1.03~2.08，P=0.04）与骨折（OR=2.34，95%CI：1.61~3.40，P<0.00001）的发生率均高于安慰剂组。
研究结论：氟西汀与西酞普兰可促进急性卒中后非抑郁患者的运动功能恢复，但需警惕氟西汀可能引发的低钠血症、癫痫发作及骨折等不良事件。
系统评价注册：PROSPERO，注册号[CRD42021227452]。