Safety of Fampridine one year on

Jara M, Barker G, Henney HR Dalfampridine extended release tablets: 1 year of postmarketing safety experience in the US. Neuropsychiatr Dis Treat. 2013;9:365-70.

BACKGROUND: Dalfampridine extended release tablets (dalfampridine-ER; prolonged-, modified, or sustained-release fampridine in some countries) were approved in the US to improve walking in patients with multiple sclerosis, as demonstrated by improvement in walking speed. Post-marketing safety experience is available from exposure of approximately 46,000 patients in the US from product approval through March 2011.

OBJECTIVE: To provide a descriptive analysis of all spontaneously reported post-marketing adverse events (AEs) for dalfampridine-ER since product launch.

METHODS: AE data were extracted from the safety database from product launch through March 31, 2011; AEs were classified using the Medical Dictionary for Regulatory Activities. Seizure cases were reviewed for patient demographics, time to event from treatment onset, and presence of additional risk factors.

RESULTS: THE MOST FREQUENTLY REPORTED POST-MARKETING AES WERE SIMILAR TO THOSE REPORTED DURING CLINICAL DEVELOPMENT: dizziness, insomnia, balance disorder, headache, nausea, urinary tract infection, asthenia, and back pain (all included in US product labelling). New clinically significant findings are related to lack of efficacy and inappropriate dosing. Of the approximately 46,000 patients exposed, 85 seizures were reported (∼5.4/1000 patient-years), of which 82 were reported or confirmed by a health care practitioner (∼5.2/1000 patient-years). Beyond the intrinsic multiple sclerosis-related seizure risk, more than half of the 85 cases (62%) had an additional potential risk factor for seizure including a previous history of convulsions, renal impairment, incorrect dosing, or use of concurrent medications with a labelled seizure risk. Duration of treatment prior to the seizure ranged from one dose to 365 days; 26/85 (31%) patients suffered a seizure within a week of starting treatment.

CONCLUSION: Spontaneous safety data from the US postmarketing experience were consistent with the safety profile seen during clinical development. Although first-year seizure incidence was not substantially different from that observed in dalfampridine-ER clinical trials, patients should be monitored for concomitant use of drugs that lower seizure threshold.

Phase IV is the monitoring that occurs after licencing of drugs. This can spot the rare side effects that can occur as more and more people use the drug. This study looks at Fampridine and the side effect profile has remained as expected. Should companies also monitor this to see if there are long-term benefits of their drugs. This would take more than a year to do. 

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  • Yes, companies should continue the trials for their drugs to monitor long term efficacy. The assumption is that reduction in relapse rate and MRI white matter activity during a two year trial translates into a reduction in disease progression over the long term. But as of yet there is no proof of this.

    Until then, it only makes sense to continue on with the trials to monitor progression with all willing patients who crossed over to the drug after the finish of the placebo controlled portion.

  • It costs money to monitor and if the company does not get the information that suits them is it easier not to collect the information in the first place.

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