Prolonged-Release Fampridine as Adjunct Therapy to Active Motor Training in MS Patients: A Pilot, Double-Blind, Randomized, Placebo-Controlled Study

François Jacques, Adrian Schembri, Avi Nativ, Chantal Paquette, Pawel Kalinowski, François Jacques, Adrian Schembri, Avi Nativ, Chantal Paquette, Pawel Kalinowski

Abstract

Background: Both prolonged-release fampridine (PRF) and enabling active motor training (EAMT) are beneficial in multiple sclerosis (MS) patients. Their combined effect is, however, understudied.

Objective: The objective of this paper is to determine if PRF augments the beneficial effect of EAMT in MS patients as opposed to placebo.

Method: This is a pilot, randomized, placebo-controlled, double-blind 14-week study. Participants were randomly assigned to receive PRF 10 mg BID (n = 21) or placebo (n = 20). All patients underwent EAMT during the first six weeks. Patients were assessed at -4, 0, 6 and 14 weeks.

Results: Both groups remained stable between -4 to 0 weeks and showed statistically significant improvements for the six-minute walk and the five-times-sit-to-stand test at weeks 6 and 14. The PRF-treated group achieved a greater mean percentage improvement and a higher incidence of responders in all three tasks at both time points. The study was, however, underpowered to reach statistical significance.

Conclusion: Our results confirm previous studies demonstrating that MS patients, despite significant disability, do benefit from a rehabilitation program. Our study is the first to show a trend suggesting that PRF in MS patients appears to enhance the benefit of EAMT. Further studies are required to confirm this.Clinical trial registration number with Clinicaltrial.gov: NCT02146534.

Keywords: Multiple sclerosis; enabled active motor training; fampridine; rehabilitation.

Figures

Figure 1.
Figure 1.
(a) Change in performance over the four time points on the six-minute walk (6MW) within the prolonged-release fampridine and control groups, with error bars at 95% confidence interval. (b) Change in performance over the four time points on the five-time-sit-to-stand test (FTSTS) within the prolonged-release fampridine and control group, with error bars at 95% confidence interval. (c) Change in performance over the four time points on the eight-meter walk (8MW) within the prolonged-release fampridine and control groups, with error bars at 95% confidence interval.

References

    1. Ghiani CA, Ying Z, de Vellis J, et al. Exercise decreases myelin-associated glycoprotein expression in the spinal cord and positively modulates neuronal growth. Glia 2007; 55: 966–975.
    1. Taubert M, Draganski B, Anwander A, et al. Dynamic properties of human brain structure: Learning-related changes in cortical areas and associated fiber connections. J Neurosci 2010; 30: 11670–11677.
    1. Bonzano L, Tacchino A, Brichetto G, et al. Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis. Neuroimage 2014; 90: 107–116.
    1. Hayes KC. Fampridine-SR for multiple sclerosis and spinal cord injury. Expert Rev Neurother 2007; 7: 453–461.
    1. Jensen HB, Mamoei S, Ravnborg M, et al. Distribution-based estimates of minimum clinically important difference in cognition, arm function and lower body function after slow release-fampridine treatment of patients with multiple sclerosis. Mult Scler Relat Disord 2016; 7: 58–60.
    1. Mainero C, Inghilleri M, Pantano P, et al. Enhanced brain motor activity in patients with MS after a single dose of 3,4-diaminopyridine. Neurology 2004; 62: 2044–2050.
    1. Judge SI andBever CT Jr. Potassium channel blockers in multiple sclerosis: Neuronal Kv channels and effects of symptomatic treatment. Pharmacol Ther 2006; 111: 224–259.
    1. Zörner B, Filli L, Reuter K, et al. Prolonged-release fampridine in multiple sclerosis: Improved ambulation effected by changes in walking pattern. Mult Scler 2016; 22: 1463–1475.
    1. Stellmann JP, Jlussi M, Neuhaus A, et al. Fampridine and real-life walking in multiple sclerosis: Low predictive value of clinical test for habitual short-term changes. J Neurol Sci 2016; 368: 318–325.
    1. Rabadi MH, Kreymborg K and, Vincent AS. Sustained-release fampridine (4-aminopyridine) in multiple sclerosis: Efficacy and impact on motor function. Drugs R D 2013; 13: 175–181.
    1. Goodman AD, Brown TR, Edwards KR, et al. A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol 2010; 68: 494–502.
    1. Goodman AD, Brown TR, Schapiro RT, et al. A pooled analysis of two phase 3 clinical trials of dalfampridine in patients with multiple sclerosis. Int J MS Care 2014; 16: 153–160.
    1. Goodman AD, Brown TR, Krupp LB, et al. Sustained-release oral fampridine in multiple sclerosis: A randomised, double-blind, controlled trial. Lancet 2009; 373: 732–738.
    1. Sagawa Y, Jr, Magnin E, Paillot L, et al. Fampridine and quality of life in individuals with multiple sclerosis. Springerplus 2016; 5: 1070.
    1. Allart E, Benoit A, Blanchard-Dauphin A, et al. Sustained-released fampridine in multiple sclerosis: Effects on gait parameters, arm function, fatigue, and quality of life. J Neurol 2015; 262: 1936–1945.

Source: PubMed

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