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Ghazi A, Osinski TL, Feng C, Horne A, Elfar J. 4-Aminopyridine treatment for nerve injury resulting from radical retro-pubic prostatectomy: a single-center double-blind, randomized, placebo-controlled study. Trials 2024; 25:332. [PMID: 38773595 PMCID: PMC11106896 DOI: 10.1186/s13063-024-08102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most common non-cutaneous malignancy in men and leads to the second most common cause of cancer related mortality in men. Early detection of PCa allows for a potentially curative intervention. Most men will live over a decade from the time of their PCa diagnosis. Thus, treatments must balance curative interventions with their impact on quality of life. Radical prostatectomy (RP) is one such potentially curative intervention but often leads to erectile dysfunction (ED) and urinary incontinence (UI). Approximately 90,000 RPs are performed each year in the USA. Post-operative ED and UI is thought to occur in part from traumatic peripheral nerve injury (TPNI) to the neurovascular bundles that surround the prostate. Thus, patients undergoing RP may be a population that would benefit from clinical studies that look at TPNI. METHODS The study is a single-institution, double-blinded placebo-controlled, randomized clinical trial in which patients immediately post-RP receive either 4-aminopyrdine (4AP) or placebo in a 1:1 fashion. The primary outcome is evaluation of the efficacy of 4AP in accelerating the early return of baseline erectile and urinary function post-radical prostatectomy. DISCUSSION This study is critical as it could reduce the morbidity associated with RP, a commonly performed operation, and identify a patient population that may greatly benefit into further TPNI research. TRIAL REGISTRATION ClinicalTrials.gov NCT03701581. Prospectively registered on October 10, 2018.
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Affiliation(s)
- Ahmed Ghazi
- Urology, Johns Hopkins University, Baltimore, United States
| | | | | | - Andrea Horne
- Orthopaedic Surgery, University of Arizona, Tucson, United States
| | - John Elfar
- Orthopaedic Surgery, University of Arizona, Tucson, United States.
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2
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Sagawa Y, Guilhendou C, Moulin T, Soares AV, Decavel P. Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results. J Exerc Rehabil 2024; 20:65-75. [PMID: 38737468 PMCID: PMC11079549 DOI: 10.12965/jer.2448128.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 05/14/2024] Open
Abstract
The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.
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Affiliation(s)
- Yoshimasa Sagawa
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
| | - Coline Guilhendou
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
| | - Thierry Moulin
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
| | - Antonio Vinicius Soares
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
- University of Joinville Region, Joinville,
Brazil
| | - Pierre Decavel
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
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3
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Paredes-Cruz M, Grijalva I, Martínez-López YE, Guizar-Sahagún G, Colín-Ramírez E, Rojano-Mejía D. Functional improvement in individuals with chronic spinal cord injury treated with 4-aminopyridine: A systematic review. Front Neurol 2022; 13:1034730. [DOI: 10.3389/fneur.2022.1034730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
Study designSystematic review.ObjectiveTo provide current evidence on the efficacy of 4-aminopyridine (4-AP) to bring about functional improvement in individuals with chronic traumatic spinal cord injury (SCI).MethodsThe Medline (PubMed), Web of Science and SCOPUS databases were systematically searched for relevant articles on the efficacy of 4-AP to treat SCI, from the dates such articles were first published until May 2022. Full-text versions of all the articles selected were examined independently by two reviewers. Methodological quality was rated using the Modified Jadad Scale, and risk of bias was assessed with the RoB-2 test. Data extracted included human models/types, PRISMA assessment protocols, and the results of each study. Descriptive syntheses are provided.ResultsIn total, 28 articles were initially identified, 10 of which were included after screening. Most of the studies reviewed reported some degree of patient improvement in one or more of the following parameters: motor, sensitivity and sexual function, sphincter control, spasticity, ability to function independently, quality of life, central motor conduction, pain, and pulmonary function.ConclusionsThis review confirms the efficacy of 4-AP in improving several conditions resulting from SCI but further research on this topic is warranted. Additional randomized clinical trials with 4-AP involving larger sample sizes are needed, as are consistent outcome measures in order to obtain adequate data for analysis with a view to enhance treatment benefits.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=334835, PROSPERO CRD42022334835.
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Zhao X, Yang H, Wei T, Zhao J, Liu J, Huang Z, Zhu L, Zhao Y, Li W. Cost-effectiveness analysis of prolonged-release fampridine to treat walking disability of multiple sclerosis in China. J Comp Eff Res 2022; 11:1057-1069. [PMID: 35894120 DOI: 10.2217/cer-2022-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: This study evaluates the cost-effectiveness of adding prolonged-release (PR)-fampridine to best supportive care (BSC) versus BSC alone in adult multiple sclerosis patients with walking disability in China. Materials & methods: A hybrid decision tree and Markov model from both the societal and healthcare perspectives were constructed. Parameters were derived from clinical trials of PR-fampridine, published sources and clinical expert interviews. Results: Over a 10-year time horizon, adding PR-fampridine to BSC led to 0.15 quality-adjusted life year (QALY) gain and lower costs, with incremental cost-effectiveness ratios of -238,806 Chinese Yuan/QALY and -113,488 Chinese Yuan/QALY from the societal and healthcare perspectives, respectively. Conclusion: Compared with BSC alone, PR-fampridine plus BSC is considered an economically dominant strategy for the treatment of multiple sclerosis-related walking disability in China.
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Affiliation(s)
- Xinran Zhao
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Han Yang
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Tian Wei
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Jin Zhao
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Jun Liu
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Zhe Huang
- Value & Access, Biogen China, Shanghai, 200031, China
| | - Lin Zhu
- Value & Access, Biogen China, Shanghai, 200031, China
| | - Yinan Zhao
- The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Wei Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China
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Hupperts R, Gasperini C, Lycke J, Ziemssen T, Feys P, Xiao S, Acosta C, Koster T, Hobart J. Efficacy of prolonged-release fampridine versus placebo on walking ability, dynamic and static balance, physical impact of multiple sclerosis, and quality of life: an integrated analysis of MOBILE and ENHANCE. Ther Adv Neurol Disord 2022; 15:17562864221090398. [PMID: 35601756 PMCID: PMC9121513 DOI: 10.1177/17562864221090398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background: MOBILE and ENHANCE were similarly designed randomized trials of
walking-impaired adults with relapsing-remitting or progressive multiple
sclerosis (MS) who received placebo or 10 mg prolonged-release
(PR)-fampridine twice daily for 24 weeks. Both studies showed sustained and
clinically meaningful improvement in broad measures of walking and balance
over 24 weeks of PR-fampridine treatment. Objective: To evaluate the functional benefits and safety of PR-fampridine
versus placebo using a post hoc
integrated efficacy analysis of MOBILE and ENHANCE data. Methods: Data from the intention-to-treat (ITT) populations of MOBILE and ENHANCE
studies were pooled in a post hoc analysis based on the
following outcome measures: 12-item MS Walking Scale (MSWS-12), Timed Up and
Go (TUG) speed, Berg Balance Scale (BBS), MS Impact Scale physical impact
subscale (MSIS-29 PHYS), EQ-5D utility index score, visual analogue scale
(VAS), and adverse events. The primary analysis was the proportion of people
with MS (PwMS) with a mean improvement in MSWS-12 score (⩾8 points) from
baseline over 24 weeks. A subgroup analysis based on baseline
characteristics was performed. Findings: In the ITT population (N = 765; PR-fampridine,
n = 383; placebo, n = 382), a greater
proportion of PR-fampridine–treated PwMS than placebo-treated PwMS achieved
a clinically meaningful improvement in the MSWS-12 scale over 24 weeks
(44.3% versus 33.0%; p < 0.001).
PR-fampridine MSWS-12 responders demonstrated greater improvements from
baseline in TUG speed, BBS score, MSIS-29 PHYS score, and EQ-5D utility
index and VAS scores versus PR-fampridine MSWS-12
nonresponders and placebo. Subgroup analyses based on baseline
characteristics showed consistency in the effects of PR-fampridine. Conclusion: The pooled analysis of MOBILE and ENHANCE confirms previous evidence that
treatment with PR-fampridine results in clinically meaningful improvements
in walking, mobility and balance, self-reported physical impact of MS, and
quality of life and is effective across a broad range of PwMS.
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Affiliation(s)
- Raymond Hupperts
- Department of Neurology, Zuyderland Medical Center, 6130 MB Sittard, The Netherlands
| | - Claudio Gasperini
- Department of Neurosciences, S. Camillo Forlanini Hospital, Rome, Italy
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, Technical University of Dresden, Dresden, Germany
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; UMSC Hasselt, Pelt, Belgium
| | | | | | | | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth Hospitals NHS Trust, Plymouth, UK
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Mamoei S, Jensen HB, Pedersen AK, Nygaard MKE, Eskildsen SF, Dalgas U, Stenager E. Clinical, Neurophysiological, and MRI Markers of Fampridine Responsiveness in Multiple Sclerosis-An Explorative Study. Front Neurol 2021; 12:758710. [PMID: 34764932 PMCID: PMC8576138 DOI: 10.3389/fneur.2021.758710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 01/18/2023] Open
Abstract
Objective: Persons with multiple sclerosis (PwMS), already established as responders or non-responders to Fampridine treatment, were compared in terms of disability measures, physical and cognitive performance tests, neurophysiology, and magnetic resonance imaging (MRI) outcomes in a 1-year explorative longitudinal study. Materials and Methods: Data from a 1-year longitudinal study were analyzed. Examinations consisted of the timed 25-foot walk test (T25FW), six spot step test (SSST), nine-hole peg test (9-HPT), five times sit-to-stand test (5-STS), symbol digit modalities test (SDMT), transcranial magnetic stimulation (TMS) elicited motor evoked potentials (MEP) examining central motor conduction times (CMCT), peripheral motor conduction times (PMCT) and their amplitudes, electroneuronography (ENG) of the lower extremities, and brain structural MRI measures. Results: Forty-one responders and eight non-responders to Fampridine treatment were examined. There were no intergroup differences except for the PMCT, where non-responders had prolonged conduction times compared to responders to Fampridine. Six spot step test was associated with CMCT throughout the study. After 1 year, CMCT was further prolonged and cortical MEP amplitudes decreased in both groups, while PMCT and ENG did not change. Throughout the study, CMCT was associated with the expanded disability status scale (EDSS) and 12-item multiple sclerosis walking scale (MSWS-12), while SDMT was associated with number of T2-weighted lesions, lesion load, and lesion load normalized to brain volume. Conclusions: Peripheral motor conduction time is prolonged in non-responders to Fampridine when compared to responders. Transcranial magnetic stimulation-elicited MEPs and SDMT can be used as markers of disability progression and lesion activity visualized by MRI, respectively. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03401307.
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Affiliation(s)
- Sepehr Mamoei
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Neurology, University Hospital of Southern Jutland, Sønderborg, Denmark.,Open Patient Data Explorative Network, Odense, Denmark.,Neurological Research Unit, MS Clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding), University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network, Odense, Denmark.,Department of Brain and Nerve Diseases, University Hospital of Lillebælt, Kolding, Denmark
| | | | - Mikkel Karl Emil Nygaard
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Fristed Eskildsen
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Neurology, University Hospital of Southern Jutland, Sønderborg, Denmark.,Neurological Research Unit, MS Clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding), University Hospital of Southern Jutland, Aabenraa, Denmark
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Dietrich M, Hartung HP, Albrecht P. Neuroprotective Properties of 4-Aminopyridine. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e976. [PMID: 33653963 PMCID: PMC7931640 DOI: 10.1212/nxi.0000000000000976] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
As an antagonist of voltage-gated potassium (Kv) channels, 4-aminopyridine (4-AP) is used as symptomatic therapy in several neurologic disorders. The improvement of visual function and motor skills and relieve of fatigue in patients with MS have been attributed to 4-AP. Its prolonged release formulation (fampridine) has been approved for the symptomatic treatment of walking disability in MS. The beneficial effects were explained by the blockade of axonal Kv channels, thereby enhancing conduction along demyelinated axons. However, an increasing body of evidence suggests that 4-AP may have additional properties beyond the symptomatic mode of action. In this review, we summarize preclinical and clinical data on possible neuroprotective features of 4-AP.
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Affiliation(s)
- Michael Dietrich
- From the Department of Neurology (M.D., H.-P.H., P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; and Brain and Mind Center (H.-P.H.), University of Sydney, Australia
| | - Hans-Peter Hartung
- From the Department of Neurology (M.D., H.-P.H., P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; and Brain and Mind Center (H.-P.H.), University of Sydney, Australia
| | - Philipp Albrecht
- From the Department of Neurology (M.D., H.-P.H., P.A.), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; and Brain and Mind Center (H.-P.H.), University of Sydney, Australia.
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8
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Improvement of walking ability in patients with adrenoleukodystrophy treated with fampridine as compassionate use. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:393-395. [DOI: 10.1016/j.nrleng.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
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9
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Acosta C, Gianinazzi M, Dort T, Armstrong N, Ryder S, Lundqvist T, Ekelund M, Lycke J. Modeling the cost-effectiveness of prolonged-release fampridine for the treatment of walking impairment in patients with multiple sclerosis in Sweden. J Med Econ 2021; 24:770-780. [PMID: 33966549 DOI: 10.1080/13696998.2021.1927746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: To evaluate the cost-effectiveness of adding prolonged-release (PR)-fampridine to best supportive care (BSC) versus BSC alone for the improvement of walking ability in patients with MS.Methods: A cost-utility analysis based on a Markov model was developed to model responders and timed 25-foot walk (T25FW) scores, accumulated costs, and quality-adjusted life-years (QALY) in adults with MS and Expanded Disability Status Scale (EDSS) scores between 4 and 7. The analysis was conducted from a Swedish societal perspective.Results: In the base-case analysis, PR-fampridine plus BSC led to a higher QALY gain than BSC alone. The largest direct cost was professional care provision followed by hospital inpatient stays while the indirect cost was the loss of earnings due to days off work. The incremental cost-effectiveness ratio (ICER) for PR-fampridine plus BSC compared with BSC alone was 57,109 Swedish Kronor (kr)/QALY (€5,607/QALY [1 kr = €0.0981762 on 8 April 2021] and $6,675/QALY [1 kr = $0.116890 on 8 April 2021]). All sensitivity analyses performed resulted in ICERs below 500,000 kr (€49,088 and $58,445).Limitations: Resource use data were not specific to the Swedish market.Conclusions: PR-fampridine represents a cost-effective treatment for MS-related walking impairment in Sweden, due to improvements in patients' quality of life and reduced healthcare resource utilization.
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Affiliation(s)
- Carlos Acosta
- Value & Market Access, Biogen International GmbH, Baar, Switzerland
| | | | - Thibaut Dort
- Value & Market Access, Biogen International GmbH, Baar, Switzerland
| | | | | | | | - Mats Ekelund
- Market Access, Biogen Sweden AB, Upplands Väsby, Sweden
| | - Jan Lycke
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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10
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Safety, Patient-Reported Well-Being, and Physician-Reported Assessment of Walking Ability in Patients with Multiple Sclerosis for Prolonged-Release Fampridine Treatment in Routine Clinical Practice: Results of the LIBERATE Study. CNS Drugs 2021; 35:1009-1022. [PMID: 34322853 PMCID: PMC8408054 DOI: 10.1007/s40263-021-00840-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prolonged-release fampridine (PR-FAM) 10-mg tablet twice daily is the only approved pharmacological treatment for improvement of walking ability in adults with multiple sclerosis (MS). LIBERATE assessed the safety/effectiveness of PR-FAM in the real-world. OBJECTIVES The aim of this study was to collect additional safety data, including the incidence rate of seizures and other adverse events (AEs) of interest, from patients with MS taking PR-FAM in routine clinical practice (including patients aged ≥ 65 years and those with pre-existing cardiovascular risk factors). Other objectives included change over time in patient-reported evaluation of physical and psychological impact of MS while taking PR-FAM, and change over time in physician-reported assessment of walking ability in MS patients taking PR-FAM. METHODS Patients with MS newly prescribed PR-FAM were recruited (201 sites, 13 countries). Demographic/safety data were collected at enrolment through 12 months. Physician-rated Clinical Global Impression of Improvement (CGI-I) scores for walking ability, and Multiple Sclerosis Impact Scale-29 (MSIS-29) were assessed. RESULTS Safety analysis included 4646 patients with 3534.8 patient-years of exposure; median (range) age, 52.6 (21-85) years, 87.3% < 65 years, and 65.7% women. Treatment-emergent AEs (TEAEs) were reported in 2448 (52.7%) patients, and serious TEAEs were reported in 279 (6.0%) patients, of whom 37 (< 1%) experienced treatment-emergent serious AEs (TESAEs) considered related to PR-FAM. AEs of special interest (AESI) occurred in 1799 (38.7%) patients, and serious AESI in 128 (2.8%) patients. Seventeen (< 1%) patients experienced actual events of seizure. Overall, 1158 (24.9%) patients discontinued treatment due to lack of efficacy. At 12 months, a greater proportion of patients on-treatment had improvement from baseline in CGI-I for walking ability versus those who discontinued (61% vs. 11%; p < 0.001). MSIS-29 physical impact score improved significantly for patients on-treatment for 12 months versus those who discontinued (mean change, baseline to 12 months: - 9.99 vs. - 0.34 points; p < 0.001). Results were similar for MSIS-29 psychological impact. CONCLUSION No new safety concerns were identified in this real-world study, suggesting that routine risk-minimization measures are effective. CGI-I and MSIS-29 scores after 12 months treatment with PR-FAM treatment show clinical benefits consistent with those previously reported. TRIAL REGISTRATION ClinicalTrials.gov: NCT01480063.
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Stolyarov ID, Petrov AM, Boyko AN. [Efficacy and safety of Kinezia (fampridine) in the complex therapy of multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:45-52. [PMID: 33340297 DOI: 10.17116/jnevro202012011145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the efficacy and safety of fampridine** (Valenta Pharm, Russia) in the complex therapy of multiple sclerosis (MS). MATERIAL AND METHODS One hundred and twenty-six patients with MS were double blind randomized to receive fampridine (n=60) or placebo (n=66). Fampridine was administered in prolonged-release form (film-coated tablets, 10 mg) at a dose of 10 mg (1 tablet) 2 times a day, for 24 weeks. The placebo group was treated in the same way. From the 12th week, all patients in the placebo group were transferred to therapy with fampridine, 10 mg 2 times a day, for another 12 weeks. Concomitant standard therapy for MS was allowed in both groups (concomitant disease-modifying medications and other treatment). The primary outcome in the study was the proportion of patients with reduced t25fw test time (determining walking speed on a 25-foot path) on at least two out of three visits compared to baseline. The mean change in Multiple Sclerosis Functional Composite (MSFC) scores from baseline was assessed at visits 4-7 (8-24 weeks). RESULTS The proportion of patients with reduced t25fw test time compared to the baseline level was 31.7% in the fampridine group, which is higher than in the placebo group - 3.0% (p<0.001). The overall result of the Multiple Sclerosis Functional Composite (MSFC) reflected a gradual improvement in the patient's condition during treatment period. The dynamics of MSFC result relative to the baseline level significantly differed (p<0.05) between the fampridine and placebo groups in favor of the fampridine group during all treatment periods. In the fampridine group, adverse events (AE) associated with disorders of the nervous system were more common: headache, dizziness, and coordination disorders. CONCLUSIONS Fampridine improves walking performance in MS patients. The Russian product fampridine has demonstrated a favorable safety profile.
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Affiliation(s)
- I D Stolyarov
- N. Bekhtereva Institute of the Human Brain RAS, St.-Petersburg, Russia
| | - A M Petrov
- N. Bekhtereva Institute of the Human Brain RAS, St.-Petersburg, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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12
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A cross-sectional comparison of performance, neurophysiological and MRI outcomes of responders and non-responders to fampridine treatment in multiple sclerosis - An explorative study. J Clin Neurosci 2020; 82:179-185. [PMID: 33317729 DOI: 10.1016/j.jocn.2020.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/10/2020] [Accepted: 10/18/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To compare baseline physical and cognitive performance, neurophysiological, and magnetic resonance imaging (MRI) outcomes and examinetheir interrelationship inparticipants with Multiple Sclerosis (MS), already established aseither responder or non-responder to Fampridine treatment, andto examine associationswiththe expanded disability status scale (EDSS) and 12-item MS walking scale (MSWS-12). METHODS Baseline data from an explorative longitudinal observational study were analyzed. Participants underwent the Timed 25-Foot Walk Test (T25FW), Six Spot Step Test (SSST), Nine-Hole Peg Test, Five Times Sit-to-Stand Test, Symbol Digit Modalities Test (SDMT), neurophysiological testing, including central motor conduction time (CMCT), peripheral motor conduction time (PMCT), motor evoked potential (MEP) amplitudesand electroneuronographyof the lower extremities, and brain MRI (brain volume, number and volume of T2-weighted lesions and lesion load normalized to brain volume). RESULTS 41 responders and 8 non-responders were examined. There were no intergroup differences inphysical performance, cognitive, neurophysiological, andMRI outcomes (p > 0.05).CMCT was associated withT25FW, SSST, EDSS, and MSWS-12,(p < 0.05). SDMT was associated with the number and volume of T2-weighted lesions, and lesion load normalized to brain volume (p < 0.05). CONCLUSION No differences were identified between responders and non-responders to Fampridine treatment regarding physical and cognitive performance, neurophysiological or MRI outcomes. The results call for cautious interpretation and further large-scale studies are needed to expand ourunderstanding of underlying mechanisms discriminating Fampridine responders and non-responders.CMCT may be used as a marker of disability and walking impairment, while SDMT was associated with white matter lesions estimated by MRI. ClinicalTrials.gov identifier: NCT03401307.
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Hartung HP, Dietrich M, Albrecht P. 4-Aminopyridine is not just a symptomatic therapy, it has a neuroprotective effect – Commentary. Mult Scler 2020; 26:1312-1314. [DOI: 10.1177/1352458520926458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Dietrich
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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14
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[Improvement of walking in patients with adrenoleukodystrophy treated with fampridine as a compassionate use]. Neurologia 2020. [PMID: 32900530 DOI: 10.1016/j.nrl.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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15
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Arpín EC. Efficacy and safety of fampridine for walking disability in multiple sclerosis. Neurodegener Dis Manag 2020; 10:277-287. [PMID: 32762492 DOI: 10.2217/nmt-2020-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fampridine is the only drug approved for the treatment of walking impairment in multiple sclerosis. Around a third of the patients on treatment obtained an improvement in walking speed during the development phase. The effects are clinically significant, appear soon after the start of the treatment and are long-lasting, but disappear soon after the drug is withdrawn. In the real-world setting, the number of patients with a significant response to the treatment seems to be higher (around 70%). The tolerance is good, with mild to moderate, and transient adverse events. The most commonly reported are insomnia, headache, fatigue, back pain, dizziness, nausea and balance disorders. The main contraindications are a history of seizures, renal impairment and concomitant treatment with OCT2 inhibitors.
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Affiliation(s)
- Eva Costa Arpín
- Hospital Clínico Universitario, Travesía da Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain
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16
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Etemadifar M, Saboori M, Chitsaz A, Nouri H, Salari M, Khorvash R, Sheibani Tehrani D, Aghababaee A. The effect of fampridine on the risk of seizure in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 43:102188. [DOI: 10.1016/j.msard.2020.102188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
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17
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Dietrich M, Koska V, Hecker C, Göttle P, Hilla AM, Heskamp A, Lepka K, Issberner A, Hallenberger A, Baksmeier C, Steckel J, Balk L, Knier B, Korn T, Havla J, Martínez-Lapiscina EH, Solà-Valls N, Manogaran P, Olbert ED, Schippling S, Cruz-Herranz A, Yiu H, Button J, Caldito NG, von Gall C, Mausberg AK, Stettner M, Zimmermann HG, Paul F, Brandt AU, Küry P, Goebels N, Aktas O, Berndt C, Saidha S, Green AJ, Calabresi PA, Fischer D, Hartung HP, Albrecht P. Protective effects of 4-aminopyridine in experimental optic neuritis and multiple sclerosis. Brain 2020; 143:1127-1142. [PMID: 32293668 DOI: 10.1093/brain/awaa062] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/08/2019] [Accepted: 01/20/2020] [Indexed: 12/30/2022] Open
Abstract
Chronic disability in multiple sclerosis is linked to neuroaxonal degeneration. 4-aminopyridine (4-AP) is used and licensed as a symptomatic treatment to ameliorate ambulatory disability in multiple sclerosis. The presumed mode of action is via blockade of axonal voltage gated potassium channels, thereby enhancing conduction in demyelinated axons. In this study, we provide evidence that in addition to those symptomatic effects, 4-AP can prevent neuroaxonal loss in the CNS. Using in vivo optical coherence tomography imaging, visual function testing and histologic assessment, we observed a reduction in retinal neurodegeneration with 4-AP in models of experimental optic neuritis and optic nerve crush. These effects were not related to an anti-inflammatory mode of action or a direct impact on retinal ganglion cells. Rather, histology and in vitro experiments indicated 4-AP stabilization of myelin and oligodendrocyte precursor cells associated with increased nuclear translocation of the nuclear factor of activated T cells. In experimental optic neuritis, 4-AP potentiated the effects of immunomodulatory treatment with fingolimod. As extended release 4-AP is already licensed for symptomatic multiple sclerosis treatment, we performed a retrospective, multicentre optical coherence tomography study to longitudinally compare retinal neurodegeneration between 52 patients on continuous 4-AP therapy and 51 matched controls. In line with the experimental data, during concurrent 4-AP therapy, degeneration of the macular retinal nerve fibre layer was reduced over 2 years. These results indicate disease-modifying effects of 4-AP beyond symptomatic therapy and provide support for the design of a prospective clinical study using visual function and retinal structure as outcome parameters.
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Affiliation(s)
- Michael Dietrich
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Valeria Koska
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christina Hecker
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Göttle
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander M Hilla
- Department of Cell Physiology, Faculty of Biology and Biotechnology, Ruhr-University Bochum, Bochum, Germany
| | - Annemarie Heskamp
- Department of Cell Physiology, Faculty of Biology and Biotechnology, Ruhr-University Bochum, Bochum, Germany
| | - Klaudia Lepka
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Issberner
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Angelika Hallenberger
- Institute of Anatomy II, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Christine Baksmeier
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia Steckel
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Lisanne Balk
- Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Benjamin Knier
- Department of Experimental Neuroimmunology, Technische Universität München, Munich, Germany
| | - Thomas Korn
- Department of Experimental Neuroimmunology, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany.,Data Integration for Future Medicine consortium (DIFUTURE), Ludwig-Maximilians University, Munich, Germany
| | - Elena H Martínez-Lapiscina
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Solà-Valls
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Praveena Manogaran
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zürich and University of Zürich, Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Elisabeth D Olbert
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zürich and University of Zürich, Zurich, Switzerland
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zürich and University of Zürich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Andrés Cruz-Herranz
- Division of Neuroinflammation and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Hao Yiu
- Division of Neuroinflammation and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Julia Button
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins Hospital, Baltimore, USA
| | | | - Charlotte von Gall
- Institute of Anatomy II, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Anne K Mausberg
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Mark Stettner
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Hannah G Zimmermann
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.,Department of Neurology, University of California, Irvine, USA
| | - Patrick Küry
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Norbert Goebels
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Carsten Berndt
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins Hospital, Baltimore, USA
| | - Ari J Green
- Division of Neuroinflammation and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, USA
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins Hospital, Baltimore, USA
| | - Dietmar Fischer
- Department of Cell Physiology, Faculty of Biology and Biotechnology, Ruhr-University Bochum, Bochum, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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18
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Gold R, Radue EW, Giovannoni G, Selmaj K, Havrdova EK, Montalban X, Stefoski D, Sprenger T, Robinson RR, Fam S, Smith J, Chalkias S, Giannattasio G, Lima G, Castro-Borrero W. Long-term safety and efficacy of daclizumab beta in relapsing-remitting multiple sclerosis: 6-year results from the SELECTED open-label extension study. J Neurol 2020; 267:2851-2864. [PMID: 32451615 PMCID: PMC7501126 DOI: 10.1007/s00415-020-09835-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE SELECTED, an open-label extension study, evaluated daclizumab beta treatment for up to 6 years in participants with relapsing multiple sclerosis who completed the randomized SELECT/SELECTION studies. We report final results of SELECTED. METHODS Eligible participants who completed 1-2 years of daclizumab beta treatment in SELECT/SELECTION received daclizumab beta 150 mg subcutaneously every 4 weeks for up to 6 years in SELECTED. Safety assessments were evaluated for the SELECTED treatment period; efficacy data were evaluated from first dose of daclizumab beta in SELECT/SELECTION. RESULTS Ninety percent (410/455) of participants who completed treatment in SELECTION enrolled in SELECTED. Within SELECTED, 69% of participants received daclizumab beta for > 3 years, 39% for > 4 years, and 9% for > 5 years; 87% of participants experienced an adverse event and 26% a serious adverse event (excluding multiple sclerosis relapse). No deaths occurred. Overall, hepatic events were reported in 25% of participants; serious hepatic events in 2%. There were no confirmed cases of immune-mediated encephalitis. Based on weeks from the first daclizumab beta dose in SELECT/SELECTION, adjusted annualized relapse rate (95% confidence interval) for weeks 0-24 was 0.21 (0.16-0.29) and remained low on continued treatment. Overall incidence of 24-week confirmed disability progression was 17.4%. Mean numbers of new/newly enlarging T2 hyperintense lesions remained low; percentage change in whole brain volume decreased over time. CONCLUSIONS The effects of daclizumab beta on clinical and radiologic outcomes were sustained for up to ~ 8 years of treatment. No new safety concerns were identified in SELECTED. TRIAL REGISTRATION Clinicaltrials.gov NCT01051349; first registered on January 15, 2010.
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Affiliation(s)
- Ralf Gold
- St. Josef-Hospital/Ruhr-University Bochum, 44791, Bochum, Germany.
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Eva Kubala Havrdova
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Villoslada P, Steinman L. New targets and therapeutics for neuroprotection, remyelination and repair in multiple sclerosis. Expert Opin Investig Drugs 2020; 29:443-459. [DOI: 10.1080/13543784.2020.1757647] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Pablo Villoslada
- Department of Psychiatry and Behavioural Sciences & Department of Neurology and Neurological Sciences, Stanford University, California, CA, USA
| | - Lawrence Steinman
- Department of Psychiatry and Behavioural Sciences & Department of Neurology and Neurological Sciences, Stanford University, California, CA, USA
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20
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Foschi M, Lugaresi A. Evaluating dalfampridine for the treatment of relapsing-remitting multiple sclerosis: does it add to the treatment armamentarium? Expert Opin Pharmacother 2019; 20:1309-1320. [PMID: 31237780 DOI: 10.1080/14656566.2019.1623879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Multiple sclerosis (MS) is a demyelinating disease, causing axonal damage and disability. Dalfampridine (DAL) is an extended-release formulation of 4-aminopyridine (4AP) and broad-spectrum voltage-dependent potassium channel blocker that is reported to improve motor, visual and cognitive functions. Furthermore, it is presently the only approved drug for walking impairment in MS. Areas covered: Herein, the authors evaluate DAL as a relapsing-remitting MS treatment, reporting and commenting on all aspects of the drug including its chemistry, safety, pharmacokinetics, and cost-effectiveness. A bibliographic search was performed on PubMed using the terms 'dalfampridine OR fampridine OR 4-aminopyridine'. Expert opinion: Evidence from post-marketing studies suggests that DAL, consistent with the effects of 4AP, may not only improve walking speed, but also arm function, fatigue, mood and cognition through restored nerve conduction in central nervous system demyelinated areas. Long-term safety data confirm that the approved dose of 10 mg twice daily is generally well tolerated. However, despite the reported efficacy, the extent of the benefits is limited in real life activities, although significant improvements have been demonstrated in the clinical setting. Patients often complain of side effects (such as cramps and painful paraesthesia) or lack of efficacy. Also, its considerably higher pricing in comparison to 4AP represents an important limitation.
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Affiliation(s)
- Matteo Foschi
- a Dipartimento di Scienze Biomediche e Neuromotorie , Università di Bologna , Bologna , Italy
| | - Alessandra Lugaresi
- a Dipartimento di Scienze Biomediche e Neuromotorie , Università di Bologna , Bologna , Italy.,b IRCCS Istituto delle Scienze Neurologiche di Bologna , UOSI Riabilitazione Sclerosi Multipla , Bologna , Italy
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21
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Hobart J, Ziemssen T, Feys P, Linnebank M, Goodman AD, Farrell R, Hupperts R, Blight AR, Englishby V, McNeill M, Chang I, Lima G, Elkins J. Assessment of Clinically Meaningful Improvements in Self-Reported Walking Ability in Participants with Multiple Sclerosis: Results from the Randomized, Double-Blind, Phase III ENHANCE Trial of Prolonged-Release Fampridine. CNS Drugs 2019; 33:61-79. [PMID: 30535670 PMCID: PMC6328522 DOI: 10.1007/s40263-018-0586-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Walking impairment is a hallmark of multiple sclerosis (MS). It affects > 90% of individuals over time, reducing independence and negatively impacting health-related quality of life, productivity, and daily activities. Walking impairment is consistently reported as one of the most distressing impairments by individuals with MS. Prolonged-release (PR)-fampridine previously has been shown to improve objectively measured walking speed in walking-impaired adults with MS. The impact of PR-fampridine from the perspective of the individual with MS warrants full and detailed examination. OBJECTIVE The objective of this study was to evaluate whether PR-fampridine has a clinically meaningful effect on self-reported walking ability in walking-impaired participants with MS. METHODS ENHANCE was a phase III, randomized, double-blind, placebo-controlled study of PR-fampridine 10 mg twice daily in walking-impaired individuals age 18-70 years with either relapsing or progressive forms of MS and an Expanded Disability Status Scale (EDSS) score of 4.0-7.0 at screening. Participants were stratified by EDSS score (≤ 6.0 or 6.5-7.0) at randomization to ensure a balanced level of disability in the treatment groups. The primary endpoint was the proportion of participants with a mean improvement in the 12-item Multiple Sclerosis Walking Scale (MSWS-12) score exceeding the predefined threshold for clinically meaningful improvement (≥ 8 points) over 24 weeks. Secondary endpoints included the proportion with ≥ 15% improvement in Timed Up and Go (TUG) speed, and mean changes in Multiple Sclerosis Impact Scale physical impact subscale (MSIS-29 PHYS), Berg Balance Scale (BBS), and ABILHAND scores over 24 weeks. RESULTS In total, 636 participants with MS were randomized (PR-fampridine, n = 317; placebo, n = 319; modified intention-to-treat sample: PR-fampridine, n = 315; placebo, n = 318). At baseline in the PR-fampridine and placebo groups, 46% and 51% had a progressive form of MS, median [range] EDSS scores were 6.0 [4.0-7.0] and 5.5 [4.0-7.0], mean [range] MSWS-12 scores were 63.6 [0-100] and 65.4 [0-100], and mean [range] TUG speed was 0.38 [0.0-1.0] and 0.38 [0.0-1.2] feet/s, respectively. A significantly higher percentage of PR-fampridine-treated participants (136/315 [43.2%]) had clinically meaningful improvement in MSWS-12 score over 24 weeks versus placebo (107/318 [33.6%]; odds ratio 1.61 [95% confidence interval 1.15-2.26]; p = 0.006). For PR-fampridine versus placebo, significantly more participants had a ≥ 15% improvement in TUG speed, and there was significantly greater mean improvement in MSIS-29 PHYS score (p < 0.05); numerical improvements that were not statistically significant were observed in BBS/ABILHAND. Adverse events that were more common in the PR-fampridine group than placebo group (difference ≥ 3%) by Medical Dictionary for Regulatory Activities (MedDRA®) Preferred Term were urinary tract infection and insomnia. There were no seizures reported. CONCLUSIONS PR-fampridine treatment resulted in sustained, clinically meaningful improvements over 24 weeks in self-reported walking and functional ability in walking-disabled participants with MS. CLINICALTRIALS. GOV IDENTIFIER NCT02219932.
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Affiliation(s)
- Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, University Hospitals Plymouth NHS Trust, N13 ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, Technical University of Dresden, Dresden, Germany
| | - Peter Feys
- BIOMED-REVAL, University of Hasselt, Diepenbeek, Belgium
| | - Michael Linnebank
- HELIOS Klinik Hagen-Ambrock, University Witten/Herdecke, Hagen, Germany
| | - Andrew D. Goodman
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Rachel Farrell
- National Hospital for Neurology and Neurosurgery, University College London Hospitals and University College London Institute of Neurology, London, UK
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22
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Panicucci E, Cohen M, Bourg V, Rocher F, Thomas P, Lebrun C. De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine. Mult Scler 2018; 25:618-621. [PMID: 30375922 DOI: 10.1177/1352458518790379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. OBJECTIVE Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. METHODS No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. RESULTS All three patients presented with CSE that was attributed to DAL and so was discontinued. CONCLUSION These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.
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Affiliation(s)
| | - Mikael Cohen
- Service de Neurologie, CRCSEP, Hôpital Pasteur 2, Nice, France
| | - Veronique Bourg
- Service de Neurologie, CRCSEP, Hôpital Pasteur 2, Nice, France
| | - Fanny Rocher
- Centre régional de Pharmacovigilance, Hôpital Cimiez, Nice, France
| | - Pierre Thomas
- Service de Neurologie, CRCSEP, Hôpital Pasteur 2, Nice, France
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23
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Albrecht P, Bjørnå IK, Brassat D, Farrell R, Feys P, Hobart J, Hupperts R, Linnebank M, Magdič J, Oreja-Guevara C, Pozzilli C, Salgado AV, Ziemssen T. Prolonged-release fampridine in multiple sclerosis: clinical data and real-world experience. Report of an expert meeting. Ther Adv Neurol Disord 2018; 11:1756286418803248. [PMID: 30305850 PMCID: PMC6174649 DOI: 10.1177/1756286418803248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/25/2018] [Indexed: 01/07/2023] Open
Abstract
Prolonged-release (PR) fampridine is the only approved medication to improve walking in multiple sclerosis (MS), having been shown to produce a clinically meaningful improvement in walking ability in the subset of MS patients with Expanded Disability Status Scale 4-7. Recent responder subgroup analyses in the phase III ENHANCE study show a large effect size in terms of an increase of 20.58 points on the patient-reported 12-item MS Walking Scale in the 43% of patients classified as responders to PR-fampridine, corresponding to a standardized response mean of 1.68. Use of PR-fampridine in clinical practice varies across Europe, depending partly on whether it is reimbursed. A group of European MS experts met in June 2017 to discuss their experience with using PR-fampridine, including their views on the patient population for treatment, assessment of treatment response, re-testing and re-treatment, and stopping criteria. This article summarizes the experts' opinions on how PR-fampridine can be used in real-world clinical practice to optimize the benefits to people with MS with impaired walking ability.
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Affiliation(s)
- Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany
| | | | - David Brassat
- Centre de Resource et de Competence-SEP CHU-Toulouse et UMR1043, Université de Toulouse III, Toulouse, France
| | - Rachel Farrell
- Department of Neuroinflammation, UCL Institute of Neurology, London and National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Peter Feys
- REVAL/BIOMED, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Jeremy Hobart
- Department of Clinical Trials and Health Research: Translational & Stratified Medicine, Plymouth
| | - Raymond Hupperts
- Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, Netherlands
| | - Michael Linnebank
- Department of Neurology, Helios Clinic Hagen-Ambrock, Hagen, Germany
| | - Jožef Magdič
- Department of Neurology, University Medical Center Maribor, Maribor, Slovenia
| | - Celia Oreja-Guevara
- Neurología, Hospital Clínico San Carlos, Departamento de Medicina, Universidad Complutense de Madrid, Spain
| | - Carlo Pozzilli
- Department of Neurology, University La Sapienza, Rome, Italy
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, MS Center Dresden, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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24
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Bakirtzis C, Konstantinopoulou E, Langdon DW, Grigoriadou E, Minti F, Nikolaidis I, Boziki MK, Tatsi T, Ioannidis P, Karapanayiotides T, Afrantou T, Hadjigeorgiou G, Grigoriadis N. Long-term effects of prolonged-release fampridine in cognitive function, fatigue, mood and quality of life of MS patients: The IGNITE study. J Neurol Sci 2018; 395:106-112. [PMID: 30308444 DOI: 10.1016/j.jns.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Studies have reported conflicting results regarding the potential benefit of prolonged release (PR) fampridine in other domains besides walking. Moreover, only a small number of studies have explored long- term effects of PR fampridine. The aim of this study was to assess cognitive function, quality of life, mood and fatigue in MS patients treated with fampridine after 6 and 12 months of treatment. METHODS IGNITE was an observational, open label study. Subjects were examined with the timed 25-ft walk (T25FW) and the BICAMS battery and were asked to complete the Multiple Sclerosis Impact Scale (MSIS-29), Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory-II (BDI-II) and MS International Quality-of-Life questionnaire (MUSIQOL) at baseline and at weeks 24 and 48. Patients were sub-grouped into responders (n:40) and non-responders (n:20) according to T25FW performance after 2 weeks on treatment. RESULTS After 6 months, statistically significant improvement was observed on T25FW (p < .001), SDMT (p < .001) and MSIS29 (p < .001), for responders. After 1 year on treatment, statistically significant improvement was observed in T25FW (p < .001), MSIS29 (p = .004), SDMT (p < .001) and MUSIQOL (p = .03) for responders. There were no statistically significant improvements for the non-responders. CONCLUSIONS PR Fampridine may have a beneficial effect on information processing speed though not on memory. Study data provide some evidence that fampridine treatment may reduce the impact of MS on daily activities and improve quality of life but has no effect on subjective fatigue and mood.
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Affiliation(s)
- C Bakirtzis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - E Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D W Langdon
- Royal Holloway, University of London, London, UK
| | - E Grigoriadou
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - F Minti
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - I Nikolaidis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - M K Boziki
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - T Tatsi
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - P Ioannidis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - T Karapanayiotides
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - T Afrantou
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - G Hadjigeorgiou
- Department of Neurology, Medical School, University of Cyprus, Cyprus
| | - N Grigoriadis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Rommer PS, Eichstädt K, Ellenberger D, Flachenecker P, Friede T, Haas J, Kleinschnitz C, Pöhlau D, Rienhoff O, Stahmann A, Zettl UK. Symptomatology and symptomatic treatment in multiple sclerosis: Results from a nationwide MS registry. Mult Scler 2018; 25:1641-1652. [PMID: 30230952 DOI: 10.1177/1352458518799580] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease. Over time, symptoms accumulate leading to increased disability of patients. OBJECTIVE The objective of this article is to analyze the prevalence of symptoms and symptomatic treatment patterns in a nationwide MS registry. METHODS Data sets from 35,755 patients were analyzed. RESULTS More than two-thirds of patients were women with a mean age of 46.1 (±12.8) years. Median Expanded Disability Status Score (EDSS) was 3.0. The most frequently reported symptoms were fatigue, spasticity, and voiding disorders. In patients with short disease duration, fatigue was reported most frequently. Symptomatic treatment was most common for spasticity and depression, whereas fatigue was treated only in a third of affected patients. Almost a fifth of patients with EDSS ⩽ 3.5 and neuropsychological symptoms had retired from work. CONCLUSION Whereas treatment for spasticity and depression is common in our cohort, sexual dysfunction, dysphagia, cognitive dysfunction, and fatigue are treated to a far lesser extent. The need for psychological support, physical, and occupational therapy has to be recognized as neuropsychological symptoms have a great impact on retirement at an early stage. Overall symptomatic treatment rates for the most common symptoms have increased over the last years (p < 0.001).
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Affiliation(s)
- Paulus Stefan Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany/Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - David Ellenberger
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Judith Haas
- MS-Center, Jewish Hospital Berlin, Berlin, Germany
| | | | - Dieter Pöhlau
- Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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Klineova S, Farber R, Friedman J, Farrell C, Lublin FD, Krieger S. Objective and subjective measures of dalfampridine efficacy in clinical practice. Mult Scler J Exp Transl Clin 2018; 4:2055217318786742. [PMID: 30090641 PMCID: PMC6077903 DOI: 10.1177/2055217318786742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022] Open
Abstract
Background Multiple sclerosis affects mobility in over 80% of patients. Dalfampridine is the only approved treatment for walking impairment in multiple sclerosis. We assessed dalfampridine utilization in our practice and investigated response using timed 25 foot walk (T25FW) improvement and a patient-reported ambulation inventory. Methods Chart review identified patients with multiple sclerosis for whom dalfampridine was prescribed. T25FW data were extracted from medical records. Participants completed a dalfampridine-specific version of the multiple sclerosis walking scale (dMSWS-12) to assess the qualitative impact of dalfampridine on ambulation. We evaluated two responder categories: liberally defined as any improvement in T25FW; and over 20% T25FW improvement. Results The dMSWS-12 questionnaire was completed by 39 patients. Eighteen patients (46%) did not show any T25FW improvement. Of the 21 patients (54%) with T25FW improvement, four patients (11%) showed improvement greater than 20%. Analysis of dMSWS-12 scores showed a median score of 40 (range 12–60). Eleven patients (28%) showed no improvement (dMSWS-12 score ≤36). In contrast to objective T25FW improvement (54%), 28 patients (72%) reported improvement in walking ability (dMSWS-12 score ≥37). Conclusion Our results suggest that T25FW alone might not be sufficient for response characterization and that adding patient-reported measures may further elucidate the therapeutic response.
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Affiliation(s)
- Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | - Rebecca Farber
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | - Joshua Friedman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | - Colleen Farrell
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | - Fred D Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
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Leussink VI, Montalban X, Hartung HP. Restoring Axonal Function with 4-Aminopyridine: Clinical Efficacy in Multiple Sclerosis and Beyond. CNS Drugs 2018; 32:637-651. [PMID: 29992409 DOI: 10.1007/s40263-018-0536-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The oral potassium channel blocker 4-aminopyridine has been used in various neurological conditions for decades. Numerous case reports and studies have supported its clinical efficacy in ameliorating the clinical presentation of certain neurological disorders. However, its short half-life, erratic drug levels, and safety-related dose restrictions limited its use as a self-compounded drug in clinical practice. This changed with the introduction of a prolonged-release formulation, which was successfully tested in patients with multiple sclerosis. It was fully approved by the US FDA in January 2010 but initially received only conditional approval from the European Medicines Agency (EMA) in July 2011. After additional clinical studies, this conditional approval was changed to unrestricted approval in August 2017. This article reviews and discusses these recent studies and places aminopyridines and their clinical utility into the context of a broader spectrum of neurological disorders, where clinical efficacy has been suggested. In 2010, prolonged-release 4-aminopyridine became the first drug specifically licensed to improve walking in patients with multiple sclerosis. About one-third of patients across disease courses benefit from this treatment. In addition, various reports indicate clinical efficacy beyond multiple sclerosis, which may broaden its use in clinical practice.
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Affiliation(s)
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain.,St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
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Positive effects of fampridine on cognition, fatigue and depression in patients with multiple sclerosis over 2 years. J Neurol 2018; 265:1016-1025. [DOI: 10.1007/s00415-018-8796-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
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29
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Callesen J, Richter C, Kristensen C, Sunesen I, Næsby M, Dalgas U, Skjerbæk AG. Test–retest agreement and reliability of the Six Spot Step Test in persons with multiple sclerosis. Mult Scler 2017; 25:286-294. [DOI: 10.1177/1352458517745725] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The Six Spot Step Test (SSST) extends traditional walking outcomes in persons with multiple sclerosis (PwMS) by further challenging components of coordination and balance. Nonetheless, the test–retest agreement of the SSST has not been investigated. Objective: To determine the within-day, day-to-day, and inter-rater agreement and reliability of the SSST in PwMS. A secondary aim was to investigate the validity of handheld timing. Methods: A total of 38 PwMS with an Expanded Disability Status Scale (EDSS) <6.5 completed two SSSTs with a 5-minute break in-between. After 2 days, this procedure was repeated. Bland–Altman analysis was performed to determine the 95% Limits of Agreement (LOA) and Intraclass Correlation Coefficient (ICC) was calculated. In a subgroup of 18 PwMS, the SSSTs were video-recorded and timed by a second investigator. Results: The relative LOA within and between days were ±15% and ±19%, while ICC were 0.987 and 0.983, respectively. A minor learning effect was found over four tests. The handheld timing error was ±0.5 seconds when compared to video-based timing. Conclusion: The SSST has an acceptable within- and between-day agreement and reliability. For interventional purposes, a change of >19% can be regarded as a real change. Valid timing can be performed by a handheld stopwatch.
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Affiliation(s)
- Jacob Callesen
- Department of Physiotherapy, Faculty of Health Science, VIA University College, Aarhus, Denmark/Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christina Richter
- Department of Physiotherapy, Faculty of Health Science, VIA University College, Aarhus, Denmark
| | - Cecilie Kristensen
- Department of Physiotherapy, Faculty of Health Science, VIA University College, Aarhus, Denmark
| | - Inger Sunesen
- Department of Physiotherapy, Faculty of Health Science, VIA University College, Aarhus, Denmark
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
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Lecat M, Decavel P, Magnin E, Lucas B, Gremeaux V, Sagawa Y. Multiple Sclerosis and Clinical Gait Analysis before and after Fampridine: A Systematic Review. Eur Neurol 2017; 78:272-286. [PMID: 28992626 DOI: 10.1159/000480729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gait impairment is one of the most disabling symptoms in people with multiple sclerosis (PwMS). Fampridine, has demonstrated a positive effect on gait speed in PwMS after 14 days of treatment but the long-term effects have not yet been demonstrated. This study reviews the long-term effects of fampridine on gait in PwMS. SUMMARY This systematic review was conducted according to the PRISMA statement. Studies were considered long term if treatment exceeded 28 days. From the 498 studies identified, 18 (2,200 patients) fulfilled all eligibility criteria. Only 3 studies followed-up patients for >1 year and one of these showed a non-significant improvement in the gait speed. Key Messages: Fampridine seems to be beneficial at improving gait speed in PwMS in the long term. Further long-term studies are needed on related gait and functional parameters.
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Affiliation(s)
- Magaly Lecat
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
- Functional Rehabilitation Center Divio, Dijon, France
| | - Pierre Decavel
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
| | - Eloi Magnin
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
- Department of Neurology, University Hospital of Besançon, Besançon, France
| | | | - Vincent Gremeaux
- Department of Rehabilitation, University Hospital of Dijon, Dijon, France
| | - Yoshimasa Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
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Fampridine Prolonged Release: A Review in Multiple Sclerosis Patients with Walking Disability. Drugs 2017; 77:1593-1602. [PMID: 28864863 DOI: 10.1007/s40265-017-0808-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Oral fampridine prolonged release (PR) [Fampyra®] is a lipid-soluble selective potassium channel blocker that is approved in the EU for the improvement of walking in adult multiple sclerosis (MS) patients with walking disability (expanded disability status scale score of 4-7). In clinical trials (MS-F203 and MS-F204) using an objective measure of walking improvement [the timed 25-foot walk (T25FW)], more than one-third of patients receiving fampridine PR achieved a consistent on-treatment improvement in walking speed (i.e. became TW responders) over 9-14 weeks of treatment. Fampridine PR recipients who fulfilled the definition of TW responder had mean improvements of ≈25% from baseline in T25FW walking speed. In a clinical trial (ENHANCE) that used a patient-rated measure of walking improvement [12-item MS walking scale (MSWS-12)], a significantly greater proportion of fampridine PR recipients than placebo recipients achieved a ≥8-point improvement on the MSWS-12 with 24 weeks of treatment. Where reported, adverse events were mostly mild or moderate in severity, and generally consistent with the underlying disease or mechanism of action of fampridine PR. Fampridine PR is a useful treatment option to consider in adult MS patients with walking disability.
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Guo A, Niyazov A, Macaulay D, Terasawa E, Schmerold L, Wu EQ, Krieger S. Inpatient Admissions and Costs Associated with Persistent Use of Dalfampridine Extended-Release in Multiple Sclerosis: A Claims Database Analysis. J Manag Care Spec Pharm 2017. [PMID: 28650249 PMCID: PMC10398050 DOI: 10.18553/jmcp.2017.23.7.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While the clinical benefits of dalfampridine extended-release (D-ER) have been established in patients with multiple sclerosis (MS) through multiple clinical trials, there is limited real-world data on D-ER use, in particular the persistent use of D-ER, and associated acute care resource utilization and costs. OBJECTIVE To examine the real-world association of D-ER use and inpatient admissions and costs among patients with MS. METHODS This study was a retrospective observational claims analysis of the MarketScan database (April 2009-March 2014). Eligible patients consisted of adult enrollees aged 18-64 years who had (a) 12 months of continuous private plan enrollment preceding (baseline) and following (follow-up) the first D-ER claim; (b) ≥ 2 MS diagnosis codes with ≥ 1 during the baseline period; (c) ≥ 2 consecutive D-ER claims; and (d) no alternate gait-impairing etiologies during the baseline and follow-up periods. Patients were separated into 2 D-ER cohorts in the main analysis: persistent (≥ 360 days of D-ER supply) and nonpersistent (< 360 days of supply) users. Sensitivity analyses were conducted, examining additional breakdowns of days of supply within the nonpersistent cohort. Inpatient admissions (all-cause and MS-related) and health care expenditures were calculated and compared between the cohorts during follow-up using Wilcoxon rank-sum and chi-square tests. Regression models were conducted, controlling for age, sex, MS relapses, comorbidities, disease-modifying therapy use, and other baseline factors, including inpatient admissions and costs. RESULTS Of 1,598 eligible patients, 719 (45.0%) were persistent D-ER users, and 879 (55.0%) were nonpersistent D-ER users. The 2 cohorts had similar demographic and clinical characteristics, with mean (SD) ages of 51.0 (8.4) and 50.6 (8.6) years and were 71.3% and 66.6% female, respectively. Compared with nonpersistent D-ER use, persistent D-ER use was associated with lower odds of all-cause inpatient admissions (OR = 0.58, P = 0.010) and MS-related inpatient admissions (OR = 0.50, P = 0.004). Persistent use was also associated with lower inpatient expenditures for all-cause admissions ($669 vs. $1,515, P = 0.002) and MS-related admissions ($388 vs. $891, P = 0.008). CONCLUSIONS Persistent D-ER use was associated with significantly lower rates of all-cause and MS-related inpatient admissions and costs. DISCLOSURES Funding for this research and medical writing assistance was provided by Acorda Therapeutics. The study sponsor was involved in all stages of the study research and manuscript preparation. Guo and Niyazov were employees of Acorda Therapeutics at the time of this study and may own stock/stock options. Wu, Macaulay, Terasawa, and Schmerold are employees of Analysis Group, which received consultancy fees from Acorda Therapeutics for this project. Krieger was a consultant for Acorda Therapeutics for this project and has the following additional financial interests to report: consulting/advisory board work with Bayer, Biogen, EMD Serono, Novartis, Genentech, Genzyme, and Teva. Study concept and design were contributed by Guo, Niyazov, Macaulay, and Wu. Macaulay, Terasawa, Schmerold, and Wu helped prepare the data, and data interpretation was performed by Krieger, Guo, Niyazov, and Macaulay, along with Terasawa and Wu. The manuscript was written by Terasawa and Schmerold, along with Macaulay, and revised by all the authors. A portion of the current research was presented in poster format at the 2106 American Academy of Neurology Annual Meeting, which took place in Vancouver, BC, Canada, on April 15-21, 2016.
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Affiliation(s)
- Amy Guo
- 1 Acorda Therapeutics, Ardsley, New York
| | | | | | | | | | - Eric Q Wu
- 3 Analysis Group, Boston, Massachusetts
| | - Stephen Krieger
- 4 Icahn School of Medicine at Mount Sinai, New York, New York
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Filli L, Zörner B, Kapitza S, Reuter K, Lörincz L, Weller D, Sutter T, Killeen T, Gruber P, Petersen JA, Weller M, Linnebank M. Monitoring long-term efficacy of fampridine in gait-impaired patients with multiple sclerosis. Neurology 2017; 88:832-841. [DOI: 10.1212/wnl.0000000000003656] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022] Open
Abstract
Objective:To expand upon the limited knowledge of the long-term effects of prolonged-release (PR) fampridine in patients with multiple sclerosis (PwMS) regarding safety, walking improvements, and changes in drug responsiveness.Methods:Fifty-three PwMS who completed the FAMPKIN core study were included in this extension trial. Drug efficacy was assessed in an open-label and randomized double-blind, placebo-controlled study design with regular baseline assessments over a period of 2 years using the Timed 25-Foot Walk (T25FW), 6-Minute Walk Test (6MWT), and 12-item MS Walking Scale (MSWS-12) as outcome measures.Results:The data showed good tolerability and persisting efficacy of PR fampridine during long-term treatment in PwMS. Significant improvements in walking speed, endurance, and self-perceived ambulatory function were observed during open-label (T25FW: +11.5%; 6MWT: 10.7%; MSWS-12: 6.1 points) and double-blind controlled treatment with PR fampridine (T25FW: +13.1%; 6MWT: 11.9%; MSWS-12: 7.4 points). Several patients showed changes in drug responsiveness over time, resulting in an increased proportion of patients exceeding 10% or 20% improvements in walking measures after long-term treatment.Conclusions:Efficacy and tolerability data confirmed PR fampridine as a valuable long-term treatment for improving ambulatory function in gait-impaired PwMS. Similar results in open-label and double-blind phases reveal that the walking tests used are objective and reliable. The considerable proportion of patients in whom responsiveness to PR fampridine changed over time emphasizes the importance of regular reassessment of drug efficacy in clinical practice to optimize treatment. Such reassessments seem to be particularly important in patients with poor initial drug responses, as this group demonstrated enhanced responsiveness after long-term treatment.Clinicaltrials.gov identifier:NCT01576354.Classification of evidence:This study provides Class II evidence that PR fampridine significantly improved gait compared to placebo in a 2-week study in PwMS who had been using PR fampridine for 2 years.
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Marzal-Alfaro MB, Martín Barbero ML, García Domínguez J, Romero-Delgado F, Martínez Ginés ML, Herranz A, Sanjurjo-Sáez M. Impact of fampridine on quality of life: clinical benefit in real-world practice. Eur J Hosp Pharm 2017; 25:138-143. [PMID: 31157008 DOI: 10.1136/ejhpharm-2016-001129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess the effectiveness and tolerability of fampridine in patients with multiple sclerosis (MS) in real clinical practice and to analyse adherence to treatment and general satisfaction of patients in terms of quality of life (QOL). Methods Patients who started treatment with fampridine from May 2014 to October 2014 were included. Primary and secondary outcomes were Timed 25-Foot Walk (T25FW) and MS Walking Scale-12 (MSWS-12) respectively, measured at baseline and 2 weeks, 3 and 6 months. Adherence was measured by the Morisky-Green questionnaire, patient satisfaction with a visual analogue scale (VAS) and QOL with improvement in mobility, self-care, daily activities, pain/discomfort or anxiety/depression. Results 30 patients (46.7% women) of mean age 39 years, mean MS duration 13.7 years, mean Expanded Disability Status Scale score 5.8, 57% with relapsing-remitting MS were included. 22 patients (73%) continued to take treatment throughout the study period. Two weeks after treatment initiation all measures improved significantly from baseline (T25FW: -7.5 s, p<0.05; MSWS-12: -36.7, p<0.05). At 6 months, walking speed and self-perceived walking ability were significantly improved (T25FW: -3.8 s, p<0.05; MSWS-12: -30.0, p<0.05). Adverse events were reported by 30% of patients. Seizures were registered in one patient. 70% of patients were adherent with treatment. Median (IQR) general satisfaction VAS score was 8 (7-9). Patients reported an improvement in mobility (70%), anxiety/depression (33.3%), self-care (23.3%), daily activities (23.3%) and pain/discomfort (3.3%). Conclusions Fampridine is effective and safe in patients with MS in real clinical practice up to 6 months. Adherence to treatment was suboptimal but patients' general satisfaction was high and fampridine improved several items of QOL.
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Affiliation(s)
- María Belén Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Luisa Martín Barbero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - JoseM García Domínguez
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Fernando Romero-Delgado
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Luisa Martínez Ginés
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Alvarez-Payero M, Valeiras-Muñoz C, Lion-Vázquez S, Piñeiro-Corrales G, Muñoz-García D, Midaglia L. Experience with fampridine in clinical practice: analysis of a possible marker of clinical response. Int J Neurosci 2017; 127:915-922. [PMID: 28054826 DOI: 10.1080/00207454.2017.1279614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF THE STUDY Approximately 85% of patients with multiple sclerosis experience reduced mobility, which negatively affects quality of life. Fampridine is the first symptomatic treatment aimed at improving gait. We analyzed effectiveness and tolerance in clinical practice. We also sought a prevalent gait pattern in responders as a potential clinical response marker. MATERIAL AND METHODS Six-month prospective study of fampridine in patients with multiple sclerosis. Response was evaluated using the Timed 25-Foot Walk Test (T25FW) and the 12-Item Multiple Sclerosis Walking Scale (MSWS-12). Response was defined as increased gait speed (≥20%) and decreased MSWS-12 score (≥4 points). RESULTS Fifty-five patients (67.3% women; mean age, 51.7 [11.1] years) with a baseline Expanded Disability Status Scale (EDSS) score of 5.8. Gait pattern was paraparetic (40%), hemiparetic (21.8%) and ataxic (38.2%). Of all patients, 70.9% demonstrated clinical benefit based on response criteria established, at the 14-d follow-up, 61.8% at 3 months and 45.5% at 6 months. A similar response pattern was observed in the MSWS-12. A significant decrease in the mean (SD) EDSS score was observed in responders at 6 months (6.1 [0.9] vs. 5.64 [0.1], p < 0.05). Adverse effects were recorded in 50.9%, although most were mild-moderate and resolved completely. We did not identify a prevalent gait pattern among responders. After a washout period, some patients received fampridine a second time obtaining response recovery. CONCLUSIONS In our patients' cohort, fampridine proved clinical benefit, being safe and well tolerated in most cases. We did not identify a gait pattern that was predictive of clinical response.
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Affiliation(s)
| | - Candelas Valeiras-Muñoz
- b Nursing , Multiple Sclerosis Unit , Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Susana Lion-Vázquez
- c Rehabilitation Department , Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | | | - Delicias Muñoz-García
- d Neurology Department , Multiple Sclerosis Unit , Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Luciana Midaglia
- d Neurology Department , Multiple Sclerosis Unit , Complejo Hospitalario Universitario de Vigo , Vigo , Spain
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Prolonged-release fampridine treatment improved subject-reported impact of multiple sclerosis: Item-level analysis of the MSIS-29. J Neurol Sci 2016; 370:123-131. [PMID: 27772740 DOI: 10.1016/j.jns.2016.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 11/21/2022]
Abstract
Prolonged-release (PR) fampridine is approved to treat walking impairment in persons with multiple sclerosis (MS); however, treatment benefits may extend beyond walking. MOBILE was a phase 2, 24-week, double-blind, placebo-controlled exploratory study to assess the impact of 10mg PR-fampridine twice daily versus placebo on several subject-assessed measures. This analysis evaluated the physical and psychological health outcomes of subjects with progressing or relapsing MS from individual items of the Multiple Sclerosis Impact Scale (MSIS-29). PR-fampridine treatment (n=68) resulted in greater improvements from baseline in the MSIS-29 physical (PHYS) and psychological (PSYCH) impact subscales, with differences of 89% and 148% in mean score reduction from baseline (n=64) at week 24 versus placebo, respectively. MSIS-29 item analysis showed that a higher percentage of PR-fampridine subjects had mean improvements in 16/20 PHYS and 6/9 PSYCH items versus placebo after 24weeks. Post hoc analysis of the 12-item Multiple Sclerosis Walking Scale (MSWS-12) improver population (≥8-point mean improvement) demonstrated differences in mean reductions from baseline of 97% and 111% in PR-fampridine MSIS-29 PHYS and PSYCH subscales versus the overall placebo group over 24weeks. A higher percentage of MSWS-12 improvers treated with PR-fampridine showed mean improvements in 20/20 PHYS and 8/9 PSYCH items versus placebo at 24weeks. In conclusion, PR-fampridine resulted in physical and psychological benefits versus placebo, sustained over 24weeks.
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Gold R, Radue EW, Giovannoni G, Selmaj K, Havrdova E, Stefoski D, Sprenger T, Montalban X, Cohan S, Umans K, Greenberg SJ, Ozen G, Elkins J. Safety and efficacy of daclizumab in relapsing-remitting multiple sclerosis: 3-year results from the SELECTED open-label extension study. BMC Neurol 2016; 16:117. [PMID: 27461166 PMCID: PMC4962457 DOI: 10.1186/s12883-016-0635-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 07/12/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Daclizumab is a humanized monoclonal antibody against CD25 that modulates interleukin 2 signaling. The SELECT TRILOGY of clinical studies (SELECT/SELECTION/SELECTED) evaluated the safety and efficacy of daclizumab in patients with relapsing-remitting multiple sclerosis (RRMS). We report the long-term safety and efficacy of daclizumab 150 mg subcutaneous every 4 weeks in patients with RRMS in the SELECTED open-label extension study. METHODS An interim intent-to-treat analysis of all enrolled patients was performed in January 2014 for this ongoing study. RESULTS The SELECTED study enrolled 90% of patients who completed SELECTION. In the safety and efficacy analysis (N = 410), median treatment time in SELECTED was 25 months (range, <1-45). Adverse events (AEs) were reported in 76% of patients, serious AEs (SAEs) excluding MS relapse in 16%, and treatment discontinuation due to AEs including multiple sclerosis (MS) relapse in 12%. AEs were primarily of mild to moderate severity, and common AEs (≥10%), excluding MS relapse, were nasopharyngitis (12%) and upper respiratory tract infection (12%). Most commonly reported SAEs (in ≥3 patients), excluding MS relapses, were increased serum hepatic enzymes, pneumonia, ulcerative colitis, and urinary tract infection (<1% each). Incidences of AE groups of interest include cutaneous events (28%), cutaneous SAEs (2%), gastrointestinal SAEs (2%), hepatic SAEs, (1%) and malignancies (1%). The incidence of AEs, SAEs, and treatment-related study discontinuations did not increase over time and no deaths were reported. The adjusted annualized relapse rate (95% confidence interval (CI)) analyzed at 6-month intervals was 0.15 (0.10-0.22) for weeks 97-120 and 0.15 (0.10-0.21) for weeks 121-144. In year 3, the adjusted mean (95% CI) number of new/newly enlarging T2 hyperintense lesions was 1.26 (0.93-1.72) and the mean (median) annualized change in brain volume was -0.32% (-0.34%). CONCLUSIONS The AE incidence did not increase with extension of therapy into year 3 in SELECTED; the safety profile was similar to that previously observed. The clinical efficacy of daclizumab was sustained over the 3 years comprising the SELECT TRILOGY, although potential selection bias cannot be excluded. TRIAL REGISTRATION Clinicaltrials.gov NCT01051349; first registered January 15, 2010.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital/Ruhr-University Bochum, Bochum, Germany
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, London School of Medicine and Dentistry, London, UK
| | | | - Eva Havrdova
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Till Sprenger
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
- DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | | | - Stanley Cohan
- Providence Multiple Sclerosis Center, Portland, OR USA
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Abstract
Multiple sclerosis (MS) is an inflammatory-demyelinating disease of the central nervous system that may entail severe levels of disability in the long term. However, independently of the level of disability, MS patients frequently experience severe fatigue that can be as disabling as objective neurological deficits. For that reason, it is mandatory to perform an early diagnosis of MS-related fatigue and start a suitable treatment as soon as possible. In clinical practice, MS-related fatigue should be assessed and managed by a multidisciplinary team involving neurologists, MS nurses, occupational therapists, and physiotherapists. When assessing a person with MS-related fatigue, the first step is to rule out potential triggers or causes of fatigue, which may be related to MS, such as urinary dysfunction, pain, or muscular spasms leading to a sleep disorder, or unrelated to it. Once these causes have been ruled out and appropriately tackled, a careful therapeutic intervention needs to be decided. Therapeutic interventions for MS-related fatigue can be pharmacological or non-pharmacological. Regarding the pharmacological treatments, although many drugs have been tested in clinical trials, only amantadine is currently recommended for this indication. Regarding the non-pharmacological approaches, they can be broadly divided into physical, psychological, and mixed physical/psychological interventions. Several studies, many of them randomised clinical trials, support the use of all these types of non-pharmacological interventions to treat MS-related fatigue. Recent publications suggest that the implementation of mixed approaches, which have a naturally comprehensive nature, may have excellent results in clinical practice, in relation not only to fatigue levels but also to more general aspects of MS.
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Affiliation(s)
- Carmen Tur
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. .,Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK.
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Jara M, Aquilina T, Aupperle P, Rabinowicz AL. Safety profile of dalfampridine extended release in multiple sclerosis: 5-year postmarketing experience in the United States. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:169-74. [PMID: 26719727 PMCID: PMC4687626 DOI: 10.2147/dhps.s97113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dalfampridine extended release tablets (dalfampridine-ER; prolonged-, modified, or sustained-release fampridine outside the US), 10 mg twice daily, was approved by the US Food and Drug Administration (FDA) in January 2010 to improve walking in people with multiple sclerosis, as determined by an increase in walking speed. OBJECTIVE To provide a descriptive analysis of reported adverse events (AEs) for commercially available dalfampridine-ER from March 2010 through March 31, 2015. METHODS Five-year postmarketing data for dalfampridine-ER were available from the exposure of approximately 107,000 patients in the US (103,700 patient-years). Commonly reported AEs (≥2% of all reported AEs) and serious AEs were determined. The incidence of reported seizures was determined and the events were further investigated. RESULTS Among the 107,000 patients exposed to dalfampridine-ER (70% female; mean age 52.1), the most common AEs were dizziness (3.7%), insomnia (3.2%), balance disorder (3%), fall (2.4%), headache (2.4%), nausea (2.1%), and urinary tract infection (2%). Other common AEs were drug ineffectiveness (5.8%), gait disturbance (4.6%), and inappropriate dosing (3.1%). Serious AEs included rare anaphylactic reactions (five cases) and drug hypersensitivity reactions (eight cases). A total of 657 seizure cases were reported (6.3/1,000 patient-years); of these, 324 were medically confirmed (3.1/1,000 patient-years). Incidence of reported seizures was stable over time. Duration of treatment prior to a seizure ranged from a single dose to >4 years; 12% of the seizures occurred within a week of starting treatment. CONCLUSION The 5-year US postmarketing safety data of dalfampridine-ER is consistent with the safety profile observed in clinical trials. Incidence of reported seizures remained stable over time. Since commercial availability in March 2010, a warning regarding the risk of anaphylaxis and severe allergic reactions was added to the US prescribing information.
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