Multiple Sclerosis
Conditions
Keywords
multiple sclerosis, MS, walking, leg strength, demyelination
Brief summary
The purpose of this study is to evaluate the long-term safety, tolerability and activity of Fampridine-SR in subjects with multiple sclerosis who have previously participated in either an Acorda Therapeutics or an Elan Corporation sponsored protocol. Subjects are eligible regardless of whether they received active drug or placebo during their participation in the previous study.
Detailed description
Under the original protocol, patients were to have their treatment dose titrated upwards from a starting dose of 10mg b.i.d. to 15mg b.i.d. and then to a stable (maintenance) dose of 20mg b.i.d. The protocol was subsequently revised to lower the maximum maintenance dose. In the most current protocol, all patients were down-titrated to 10mg b.i.d. and maintained at this dose for the greater part of the duration of the study. Multiple Sclerosis (MS) is a disorder of the body's immune system that affects the central nervous system (CNS). Normally, nerve fibers carry electrical impulses through the spinal cord, providing communication between the brain and the arms and legs. In people with MS, the fatty sheath that surrounds and insulates the nerve fibers (called myelin) deteriorates, causing nerve impulses to be slowed or stopped. As a result, patients with MS may experience periods of muscle weakness and other symptoms such as numbness, loss of vision, loss of coordination, paralysis, spasticity, mental and physical fatigue and a decrease in the ability to think and/or remember. These periods of illness may come (exacerbations) and go (remissions). Fampridine-SR is an experimental drug that has been reported to possibly improve muscle strength and walking ability for some people with MS. This study will evaluate the effects and possible risks of taking Fampridine-SR in MS patients over a long period of time.
Interventions
DRUGFampridine-SR b.i.d. (Twice Daily)
Dosage form - tablets.
Sponsors
Acorda Therapeutics
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* The subject must have been previously enrolled in an Acorda Therapeutics or an Elan Corporation sponsored study for multiple sclerosis and received either Fampridine or placebo. * The subject must have multiple sclerosis as determined by the Principal Investigator. * The subject, male or female, must be at least 18 years of age. Any subject who is now over the age of 70 must be in good overall health in the judgment of the Investigator. * The subject must be of adequate cognitive function, as judged by the Investigator. * Any subject who is female and of childbearing potential, regardless of sexual activity, must have a negative urine pregnancy test at the Screening Visit.
Exclusion criteria
* The subject is a female who is either pregnant or breastfeeding, or of child-bearing potential, who, if engaged in active heterosexual relations and has not had a hysterectomy or bilateral oophorectomy, would not use one of the following birth control methods: tubal ligation, implantable contraception device, oral, injectable or transdermal contraceptive, barrier method or sexual activity restricted to vasectomized partner. * The subject withdrew from a previous Fampridine study because of a Serious Adverse Event that was possibly, probably or definitely related to Fampridine. * The subject has a history of seizures or has evidence of past, or possible, epileptiform activity on an EEG. * The subject has either a clinically significant abnormal ECG or laboratory value(s) at the Screening Visit, as judged by the Investigator * The subject has angina, uncontrolled hypertension, clinically significant cardiac arrhythmias, or any other clinically significant cardiovascular abnormality, as judged by the Investigator. * The subject has a known allergy to pyridine-containing substances or any of the inactive ingredients of the Fampridine tablet * The subject has received an investigational drug, except for Fampridine- SR (or matching placebo) under Protocol MS-F202, within 30 days prior to the Screening Visit; or the subject is scheduled to enroll in an investigational drug trial at any time during this study. * The subject has received compounded 4-aminopyridine (4-AP) within 14 days of the Screening Visit. * The subject has had an onset of an MS exacerbation within 30 days prior to the Screening Visit, or, if in the judgment of the Investigator, has not stabilized from a prior exacerbation episode. * The subject has started on a concomitant medication regimen for an underlying disease/symptom within the past 7 days; or has started an interferon or chemotherapeutic agent for multiple sclerosis within the past 4 weeks. * The subject has a history of drug or alcohol abuse within the past year.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Summary of Treatment Emergent Adverse Events (TEAE). | over 7 years (2004-2011) | All adverse events reported were treatment emergent. Therefore, events that had a date of onset, or worsening, on or after the start of the open-label drug and up to 14 days after the last dose (for non-serious events) or up to 30 days after the last dose (for SAEs) were summarized. Any abnormal clinically significant changes in physical examination, medical history, clinical laboratory testing, 12-lead ECG, and standard EEG testing were captured as adverse events. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Timed 25 Foot Walk (T25FW) | Screening visit, visit 4, every 12 weeks thereafter, Last Regular Visit, Follow Up Visit and Early Termination Visit | — |
| Subject Global Impression (SGI) | visit 1 and every clinic visit | The patient was asked to complete a Subject Global Impression (SGI) questionnaire at Visit 1 and every study visit thereafter except the Follow-up visit. This questionnaire asked the patient to rate the effects of the investigational drug on his/her physical well-being during the preceding week, using a 1 to 7 point scale (1 = terrible, 7 = delighted) |
| Clinician Global Impression of Change (CGIC) | visit 1 and every clinic visit | The CGIC was based on the Investigator's overall impression of the patient's neurological status and general state of health related to his or her participation in the study, specifically in regard to signs and symptoms associated with MS. Neurological status was rated according to a 1 to 7 point scale (1 = very much improved, 7 = very much worse) |
| Expanded Disability Status Scale (EDSS) | Screening visit, visit 6 and every 24 months thereafter | Based on the baseline neurological exam, each patient was scored according to the Expanded Disability Status Scale, which rates disability on a 0 to 10 scale (0 = normal neurologic examination, 10 = death) \*EDSS assessments were not well synchronized to study period because of wide differences in interval between screening and initiation |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Fampridine-SR b.i.d. (Twice Daily) All subjects (N=177) received 10mg b.i.d. Tablets.
(N=175) subjects received 15mg b.i.d and (N=7) subjects received 20mg b.i.d at some point in the study. | 177 |
| Total | 177 |
Baseline characteristics
| Characteristic | Fampridine-SR b.i.d. (Twice Daily) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 3 Participants |
| Age, Categorical Between 18 and 65 years | 174 Participants |
| Age Continuous | 51.9 years STANDARD_DEVIATION 7.67 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants |
| Race (NIH/OMB) More than one race | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 171 Participants |
| Sex: Female, Male Female | 111 Participants |
| Sex: Female, Male Male | 66 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 176 / 177 |
| serious Total, serious adverse events | 65 / 177 |
Outcome results
Primary
Summary of Treatment Emergent Adverse Events (TEAE).
All adverse events reported were treatment emergent. Therefore, events that had a date of onset, or worsening, on or after the start of the open-label drug and up to 14 days after the last dose (for non-serious events) or up to 30 days after the last dose (for SAEs) were summarized. Any abnormal clinically significant changes in physical examination, medical history, clinical laboratory testing, 12-lead ECG, and standard EEG testing were captured as adverse events.
Time frame: over 7 years (2004-2011)
Population: Safety Population. No imputation for missing data
| Arm | Measure | Group | Value (NUMBER) | Dispersion |
|---|---|---|---|---|
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Patients with Any AE | 176 participants | 99.4 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Patients with Any Serious AE | 65 participants | 36.7 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Patients with Any Possibly/Probably Related AE | 102 participants | 41.8 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Patients withdrawn due to AE | 34 participants | 15.3 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Patients who Died | 5 participants | 2.3 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Maximum Severity/Patients with Any TEAE -Mild | 10 participants | 8.5 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Maximum Severity/Patients with Any TEAE -Moderate | 66 participants | 38.4 |
| Fampridine-SR b.i.d. | Summary of Treatment Emergent Adverse Events (TEAE). | Maximum Severity/Patients with Any TEAE -Severe | 100 participants | 47.5 |
Secondary
Clinician Global Impression of Change (CGIC)
The CGIC was based on the Investigator's overall impression of the patient's neurological status and general state of health related to his or her participation in the study, specifically in regard to signs and symptoms associated with MS. Neurological status was rated according to a 1 to 7 point scale (1 = very much improved, 7 = very much worse)
Time frame: visit 1 and every clinic visit
Population: ITT Population. No imputation for missing data
| Arm | Measure | Group | Value (MEDIAN) | Dispersion |
|---|---|---|---|---|
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=176) >0-8 Weeks | 3.37 units on a scale | Standard Deviation 0.59 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=168) >8-16 Weeks | 3.47 units on a scale | Standard Deviation 0.97 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=163) >16-42 Weeks | 3.60 units on a scale | Standard Deviation 0.83 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=148) >42-68 Weeks | 3.80 units on a scale | Standard Deviation 0.89 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=137) >68-94 Weeks | 3.83 units on a scale | Standard Deviation 0.89 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=128) >94-120 Weeks | 3.76 units on a scale | Standard Deviation 0.89 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=124) >120-146 Weeks | 3.70 units on a scale | Standard Deviation 0.98 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=116) >146-172 Weeks | 3.96 units on a scale | Standard Deviation 1.05 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=102) >172-198 Weeks | 3.89 units on a scale | Standard Deviation 0.82 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=92) >198-224 Weeks | 3.75 units on a scale | Standard Deviation 1.02 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=87) >224-250 Weeks | 3.79 units on a scale | Standard Deviation 0.83 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=83) >250-276 Weeks | 3.87 units on a scale | Standard Deviation 1.11 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=80) >276-302 Weeks | 4.29 units on a scale | Standard Deviation 1.28 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=73) >302-328 Weeks | 4.27 units on a scale | Standard Deviation 1.34 |
| Fampridine-SR b.i.d. | Clinician Global Impression of Change (CGIC) | (N=13) >328-354 Weeks | 3.81 units on a scale | Standard Deviation 1.75 |
Secondary
Expanded Disability Status Scale (EDSS)
Based on the baseline neurological exam, each patient was scored according to the Expanded Disability Status Scale, which rates disability on a 0 to 10 scale (0 = normal neurologic examination, 10 = death) \*EDSS assessments were not well synchronized to study period because of wide differences in interval between screening and initiation
Time frame: Screening visit, visit 6 and every 24 months thereafter
Population: ITT Population. No imputation for data missing
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Fampridine-SR b.i.d. | Expanded Disability Status Scale (EDSS) | (N=166) Baseline | 6.04 units on a scale | Standard Deviation 1.09 |
| Fampridine-SR b.i.d. | Expanded Disability Status Scale (EDSS) | (N=92) >8-16 Weeks | 6.14 units on a scale | Standard Deviation 0.91 |
| Fampridine-SR b.i.d. | Expanded Disability Status Scale (EDSS) | (N=114) >42-68 Weeks | 6.26 units on a scale | Standard Deviation 1.2 |
| Fampridine-SR b.i.d. | Expanded Disability Status Scale (EDSS) | (N=56) >146-172 Weeks | 6.03 units on a scale | Standard Deviation 1.31 |
Secondary
Subject Global Impression (SGI)
The patient was asked to complete a Subject Global Impression (SGI) questionnaire at Visit 1 and every study visit thereafter except the Follow-up visit. This questionnaire asked the patient to rate the effects of the investigational drug on his/her physical well-being during the preceding week, using a 1 to 7 point scale (1 = terrible, 7 = delighted)
Time frame: visit 1 and every clinic visit
Population: ITT Population. No imputation for missing data
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=168) >8-16 Weeks | 4.70 units on a scale | Standard Deviation 1.31 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=176) >0-8 Weeks | 4.79 units on a scale | Standard Deviation 0.89 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=163) >16-42 Weeks | 4.71 units on a scale | Standard Deviation 1.09 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=148) >42-68 Weeks | 4.42 units on a scale | Standard Deviation 1.09 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=137)>68-94 Weeks | 4.67 units on a scale | Standard Deviation 1.11 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=128) >94-120 Weeks | 4.70 units on a scale | Standard Deviation 1.17 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=124) >120-146 Weeks | 4.73 units on a scale | Standard Deviation 1.21 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=114) >146-172 Weeks | 4.76 units on a scale | Standard Deviation 1.29 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=102) >172-198 Weeks | 4.84 units on a scale | Standard Deviation 1.27 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=91) >198-224 Weeks | 5.15 units on a scale | Standard Deviation 1.15 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=88) >224-250 Weeks | 5.10 units on a scale | Standard Deviation 1.29 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=84) >250-276 Weeks | 5.04 units on a scale | Standard Deviation 1.16 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=81) >276-302 Weeks | 4.91 units on a scale | Standard Deviation 1.47 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=74) >302-328 Weeks | 5.28 units on a scale | Standard Deviation 1.21 |
| Fampridine-SR b.i.d. | Subject Global Impression (SGI) | (N=12) >328-354 Weeks | 5.08 units on a scale | Standard Deviation 1.4 |
Secondary
Timed 25 Foot Walk (T25FW)
Time frame: Screening visit, visit 4, every 12 weeks thereafter, Last Regular Visit, Follow Up Visit and Early Termination Visit
Population: ITT Population. No imputation for missing data
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=153) Baseline | 1.87 feet/second | Standard Deviation 0.94 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=134) >8-16 Weeks | 2.09 feet/second | Standard Deviation 1.03 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=1) >0-8 Weeks | 1.98 feet/second | — |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=141) >16-42 Weeks | 2.02 feet/second | Standard Deviation 1.04 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=127) >42-68 Weeks | 1.82 feet/second | Standard Deviation 0.1 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=111) >68-94 Weeks | 1.85 feet/second | Standard Deviation 1.05 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=103) >94-120 Weeks | 1.77 feet/second | Standard Deviation 1.05 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=92) >120-146 Weeks | 1.88 feet/second | Standard Deviation 0.1 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=86) >146-172 Weeks | 1.84 feet/second | Standard Deviation 1.06 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=76) >172-198 Weeks | 1.93 feet/second | Standard Deviation 1.34 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=66) >198-224 Weeks | 1.82 feet/second | Standard Deviation 1.07 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=56) >224-250 Weeks | 2.05 feet/second | Standard Deviation 1.16 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=52) >250-276 Weeks | 2.03 feet/second | Standard Deviation 1.08 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=54) >276-302 Weeks | 1.96 feet/second | Standard Deviation 1.09 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=50) >302-328 Weeks | 1.98 feet/second | Standard Deviation 1.12 |
| Fampridine-SR b.i.d. | Timed 25 Foot Walk (T25FW) | (N=10) >328-354 Weeks | 1.89 feet/second | Standard Deviation 1.57 |