Abstract
Background
Medication used to treat multiple sclerosis (MS) can be categorized as disease-modifying
therapies, symptomatic therapies, or treatment of acute exacerbations. Dalfampridine
is the first symptomatic therapy approved by the Food and Drug Administration to improve
walking in patients with MS.
Objective
This article reviews the pharmacology, pharmacodynamic properties, and pharmacokinetic
properties of dalfampridine, as well as its clinical efficacy, safety profile, pharmacoeconomic
considerations, and place in therapy.
Methods
Three PubMed searches were conducted for original articles published in English between
1966 and August 2012 with human study participants. Articles concerning the pharmacology, pharmacokinetic properties, pharmacodynamic
properties, efficacy, and safety profile of dalfampridine were evaluated.
Results
Dalfampridine theoretically works to improve conduction and enhance walking by inhibiting
potassium channels in the axonal membrane and by prolonging action potentials in demyelinated
neurons. The efficacy of dalfampridine has been reported in 2 Phase III clinical trials
in patients with MS. When comparing dalfampridine 10 mg twice daily with placebo,
these studies found a statistically significant improvement in walking (42.9% vs 9.3%
and 35% vs 8%; P < 0.001). However, clinical trials and postmarketing surveillance have found a statistically
significant increased risk of seizures with dalfampridine.
Conclusions
Dalfampridine has a unique mechanism of action, leading to its approval as the first
symptomatic therapy for MS to improve walking speed. The increased risk of seizures
can be a significant safety concern and will require health care providers to be diligent
in monitoring patients and to ensure adequate patient education. The addition of dalfampridine
as symptomatic therapy for MS may lead to additional novel products in the future.
Key words
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Article info
Publication history
Published online: November 05, 2012
Accepted:
October 5,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
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- CorrectionsClinical TherapeuticsVol. 35Issue 6
- PreviewIn the article by Michael D. Egeberg, Caleb Y. Oh, and Jacquelyn L. Bainbridge, titled “Clinical Overview of Dalfampridine: An Agent With a Novel Mechanism of Action to Help With Gait Disturbances” (Clin Ther. 2012;34:2185-2194), the authors overstated the statistical significance of the increased risk of seizures with dalfampridine in the following places and regret the error. Statements in the manuscript referring to a statistical significance of the seizure risk associated with dalfampridine should be modified to read as follows:
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