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Sanders DB, Juel VC, Harati Y, Smith AG, Peltier AC, Marburger T, Lou JS, Pascuzzi RM, Richman DP, Xie T, Demmel V, Jacobus LR, Aleš KL, Jacobus DP. 3,4-diaminopyridine base effectively treats the weakness of Lambert-Eaton myasthenia. Muscle Nerve 2018; 57:561-568. [PMID: 29280483 PMCID: PMC5900968 DOI: 10.1002/mus.26052] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 01/24/2023]
Abstract
Introduction: 3,4‐diaminopyridine has been used to treat Lambert‐Eaton myasthenia (LEM) for 30 years despite the lack of conclusive evidence of efficacy. Methods: We conducted a randomized double‐blind placebo‐controlled withdrawal study in patients with LEM who had been on stable regimens of 3,4‐diaminopyridine base (3,4‐DAP) for ≥ 3 months. The primary efficacy endpoint was >30% deterioration in triple timed up‐and‐go (3TUG) times during tapered drug withdrawal. The secondary endpoint was self‐assessment of LEM–related weakness (W‐SAS). Results: Thirty‐two participants were randomized to continuous 3,4‐DAP or placebo groups. None of the 14 participants who received continuous 3,4‐DAP had > 30% deterioration in 3TUG time versus 72% of the 18 who tapered to placebo (P < 0.0001). W‐SAS similarly demonstrated an advantage for continuous treatment over placebo (P < 0.0001). Requirement for rescue and adverse events were more common in the placebo group. Discussion: This trial provides significant evidence of efficacy of 3,4‐DAP in the maintenance of strength in LEM. Muscle Nerve57: 561–568, 2018
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Affiliation(s)
- Donald B Sanders
- Department of Neurology, Duke University Medical Center, Box 3403, Durham, North Carolina, 27710, USA
| | - Vern C Juel
- Department of Neurology, Duke University Medical Center, Box 3403, Durham, North Carolina, 27710, USA
| | - Yadollah Harati
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - A Gordon Smith
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amanda C Peltier
- Department of Neurology, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Tessa Marburger
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jau-Shin Lou
- Department of Neurology, University of North Dakota School of Medicine & Health Science, Fargo, North Dakota, USA
| | - Robert M Pascuzzi
- Department of Neurology, Indiana University, Indianapolis, Indiana, USA
| | - David P Richman
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, California, USA
| | - Tai Xie
- Brightech International LLC, Somerset, New Jersey, USA
| | | | | | - Kathy L Aleš
- Jacobus Pharmaceutical Company, Princeton, New Jersey
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