Efficacy of Various Doses of Dextromethorphan/Quinidine to Treat Pseudobulbar Affect in MS and ALS: A Systematic Review and Network Meta-analysis
Irra Tariq1, Muneeb Ahmad Muneer2, Eeshal Zulfiqar3, Sonia Hurjkaliani3, Inshal Jaffery3, Shaila Sharmin Saaki4, Syed Muhammad Nasir Abbas Bokhari5
1United Medical and Dental College, Karachi, 2Allama Iqbal Medical College, 3Dow University of Health Sciences, 4Dhaka Medical College and Hospital, 5Dow International Medical College, DUHS, karachi
Objective:
To assess the relative efficacy of various doses of dextromethorphan/quinidine in treating pseudobulbar affect in patients with Multiple Sclerosis and Amyotrophic Lateral Sclerosis.
Background:
Pseudobulbar affect (PBA) involves sudden, uncontrollable laughing or crying that doesn't align with the individual's emotions. While SSRIs and tricyclic antidepressants have been used, they often fail to prevent symptom exacerbations. This network meta-analysis evaluates various doses of dextromethorphan/quinidine (DM/Q) for treating PBA in patients with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS).
Design/Methods:
A systematic search was conducted in PubMed/MEDLINE, Cochrane, EMBASE, Scopus, and ClinicalTrials.gov to identify randomized controlled trials (RCTs) on interventions for PBA, including studies up to July 2024. The primary outcome was the Center for Neurologic Studies-Lability Scale (CNS-LS), analyzed through pairwise and network meta-analysis, yielding standardized mean differences (SMD).
Results:
For the specific analysis of the primary outcome variable, CNS-LS, two trials with a pooled population of 476 and three pairwise comparisons were included. One study focused on patients with MS, while the other involved a mixed population of MS and ALS patients. DM/Q 20/10 mg demonstrated the greatest impact with an SMD of -0.44 (95% CI: -0.71 to -0.17), followed closely by DM/Q 30/10 mg with an SMD of -0.43 (95% CI: -0.70 to -0.16), both statistically significant. In contrast, DM/Q 30/30 mg had an SMD of 0.85 (95% CI: 0.51 to 1.18). Nausea and fatigue were more commonly associated with DM/Q 30/30 mg, with risk ratios (RR) of 1.50 (95% CI: 0.76 to 2.99) and 1.79 (95% CI: 0.70 to 4.58), respectively.
Conclusions:
DM/Q 20/10 mg and DM/Q 30/10 mg showed statistically significant outcomes in improving the condition of patients with fewer side effects. In contrast, DM/Q 30/30 mg was associated with more side effects and lower efficacy. Further research is required to validate these results.
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