Trend Toward Survival Benefit Seen for REM-Inhibition in ALS

REM inhibition via receipt of antidepressant medications associated with trend toward survival benefit

By Elana Gotkine HealthDay Reporter

THURSDAY, May 22, 2025 (HealthDay News) — For patients with amyotrophic lateral sclerosis (ALS), rapid eye movement (REM) inhibition via receipt of antidepressant medication is associated with a trend toward survival benefit, according to a study presented at the American Thoracic Society 2025 International Conference, held from May 18 to 21 in San Francisco.

Cosmo Fowler, M.D., from the Emory University School of Medicine in Atlanta, and colleagues queried the TriNetX research network to examine whether pharmacological suppression of REM sleep can improve sleep disordered breathing and nocturnal hypoxemia in ALS. Data were included for 17,444 patients with ALS who had been prescribed riluzole; 14.3 percent comprised the REM-inhibited cohort (patients were prescribed one of several antidepressant medications associated with the suppression of REM sleep in the three years preceding inclusion criteria) and 2.1 percent comprised the non-REM-inhibited cohort (patients received antidepressants not linked to REM suppression). Patients who received prescriptions from both classes were excluded.

The researchers found that prior to propensity-score matching using age, race, and gender, the REM-inhibited group had significantly higher two-year Kaplan-Meier survival (47.18 versus 41.06 percent), with a hazard ratio of 1.21 (95 percent confidence interval, 1.022 to 1.433). After matching, the survival benefit trend persisted but did not reach significance (48.13 versus 41.06 percent; hazard ratio, 1.23; 95 percent confidence interval, 0.981 to 1.547). A consistent treatment effect was suggested by preserved proportionality throughout follow-up.

“While our investigation was limited by its retrospective nature and potential confounding factors inherent to electronic health record data, the results suggest that pharmacologically targeting a period of known vulnerability in ALS may have meaningful clinical impact,” the authors write.