Efficacy and safety of xaliproden in amyotrophic lateral sclerosis: results of two phase III trials.

Abstract

Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive and fatal motor neuron disease. We carried out two randomized, double-blind, placebo-controlled, multi-centre, multi-national studies with xaliproden (a drug with neurotrophic effect) to assess drug efficacy and safety at two doses. Patients with clinically probable or definite ALS of more than 6 months and less than 5 years duration were randomly assigned to placebo, 1 mg or 2 mg xaliproden orally once daily as monotherapy in Study 1 (n=867); or to the same regimen with addition of riluzole 50 mg bid background therapy in Study 2 (n=1210 patients). The two primary endpoints were defined as: 1. Time to death, tracheostomy, or permanent assisted ventilation (DTP), and 2. Time to vital capacity (VC)<50% or DTP before (log-rank test) and after adjustment using a Cox proportional hazard model for prespecified prognostic factors. Secondary endpoints were rates of change of various functional measures. In Study 1, primary outcome measures did not reach statistical significance. For the 2 mg group, for time to VC<50% analysis (without DTP) a significant 30% RRR was obtained (95% confidence interval [CI]: 8.46, P=0.009). In Study 2, no significant results were obtained. However, there was a trend in favour of add-on 1 mg dose xaliproden vs. placebo (RRR 15% [-6.31, ns] for time to VC<50%; RRR 12% [CI: -6.27, ns] for time to VC<50% or DTP). Adjusted RR ratios were consistently more favourable for the xaliproden groups. Tolerability was good, and dose-dependent side effects were largely associated with the serotonergic properties of xaliproden. An effect of xaliproden on functional parameters, especially VC, was noted. Although this effect did not reach statistical significance, xaliproden had a small effect on clinically noteworthy aspects of disease progression in ALS.

• Authors: Vincent Meininger, Gilbert Bensimon, Walter R Bradley, Benjamin Brooks, Patrice Douillet, Andrew A Eisen, Lucette Lacomblez, P Nigel Leigh, Wim Robberecht
• Journal: Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases (Amyotroph Lateral Scler Other Motor Neuron Disord) Vol. 5 Issue 2 Pg. 107-17 (Jun 2004) ISSN: 1466-0822 [Print] England
• PMID: 15204012 (Publication Type: Clinical Trial, Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Naphthalenes
• Pyridines
• xaliproden

Topics

• Adult
• Aged
• Amyotrophic Lateral Sclerosis (drug therapy, physiopathology)
• Analysis of Variance
• Confidence Intervals
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Naphthalenes (adverse effects, therapeutic use)
• Pyridines (adverse effects, therapeutic use)