Ultra-high-dose methylcobalamin in amyotrophic lateral sclerosis: a long-term phase II/III randomised controlled study

Ryuji Kaji, Takashi Imai, Yasuo Iwasaki, Koichi Okamoto, Masanori Nakagawa, Yasuo Ohashi, Takao Takase, Takahisa Hanada, Hiroki Shimizu, Kunio Tashiro, Shigeki Kuzuhara, Ryuji Kaji, Takashi Imai, Yasuo Iwasaki, Koichi Okamoto, Masanori Nakagawa, Yasuo Ohashi, Takao Takase, Takahisa Hanada, Hiroki Shimizu, Kunio Tashiro, Shigeki Kuzuhara

Abstract

Objective: To evaluate the efficacy and safety of intramuscular ultra-high-dose methylcobalamin in patients with amyotrophic lateral sclerosis (ALS).

Methods: 373 patients with ALS (El Escorial definite or probable; laboratory-supported probable; duration ≤36 months) were randomly assigned to placebo, 25 mg or 50 mg of methylcobalamin groups. The primary endpoints were the time interval to primary events (death or full ventilation support) and changes in the Revised ALS Functional Rating Scale (ALSFRS-R) score from baseline to week 182. Efficacy was also evaluated using post-hoc analyses in patients diagnosed early (entered ≤12 months after symptom onset).

Results: No significant differences were detected in either primary endpoint (minimal p value=0.087). However, post-hoc analyses of methylcobalamin-treated patients diagnosed and entered early (≤12 months' duration) showed longer time intervals to the primary event (p<0.025) and less decreases in the ALSFRS-R score (p<0.025) than the placebo group. The incidence of treatment-related adverse events was similar and low in all groups.

Conclusion: Although ultra-high-dose methylcobalamin did not show significant efficacy in the whole cohort, this treatment may prolong survival and retard symptomatic progression without major side effects if started early.

Trial registration number: NCT00444613.

Conflict of interest statement

Competing interests: RK received grants from Eisai during the conduct of the study and has a patent on the Method of treating amyotrophic lateral sclerosis (US 20130344081 A1 licensed). TI received grants from Eisai during the conduct of the study. YI reports no disclosures. KO reports no disclosures. MN reports no disclosures. YO received personal fees from Statcom, Sanofi, Eisai, Chugai, Taiho, Shionogi and Kowa, and non-financial support from Yakult Honsha and Takeda outside the submitted work. TT is employed by Eisai. TH is employed by Eisai. HS is employed by Eisai. KT received grants from Eisai during the conduct of the study. SK received grants from Eisai during the conduct of the study.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Patient flow.
Figure 2
Figure 2
Primary efficacy endpoints in all patients (A, B) and the subgroup of patients diagnosed early (≤12 months after symptom onset) (C, D). ALSFRS-R, Revised Amyotrophic Lateral Sclerosis Functional Rating Scale.

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