抄録
Background: Accumulating evidence suggests that neuro-inflammation has a crucial role in the pathogenesis of late onset depression. Tumor Necrosis Factors-alpha (TNF-alpha) is one of many pro-inflammatory cytokines associated with depression. Based on this, this proof-of-concept clinical trial, was conducted so as to study the effect of pentoxifylline, an anti TNF-alpha as an add on to increase the effectiveness of Selective Serotonin Reuptake Inhibitors in elderly depressed patients.
Methods: A randomized, double-blinded placebo controlled trial was conducted, with 20 patients in each of its two arms. In one arm, patients received escitalopram and placebo. In the other arm, patients received escitalopram and twice daily pentoxifylline (400 mg/tab). The clinical outcome was assessed by Hamilton Depression Rating Scale and Geriatric Depression Scale. The serum levels of TNF-alpha were measured before and after treatments. Patients were followed up for 12 weeks.
Results: There was a trend for more remission and less need for dose escalation when using pentoxifylline as add-on therapy to escitalopram. There was a statistically significant difference between the initial response to escitalopram after 6 weeks and the prognostic course of depression. The effect size was clinically significant as the number-needed-to-treat for pentoxifylline was 3.3 which sounds promising. On the other hand, there was no statistically significant difference between serum level of TNF-alpha at the end of study between groups.
Conclusion: The clinical data suggest that, pentoxifylline add on therapy to escitalopram leads to more remission, less need for dose escalation during treatment and increased initial response. On the other hand, the study couldn't refer this result to the anti TNF-alpha effect of pentoxifylline.
