A single blind randomized controlled clinical trial of mexiletine in amyotrophic lateral sclerosis: Efficacy and safety of sodium channel blocker phase II trial

Kazumoto Shibuya, Sonoko Misawa, Hideki Kimura, Yu Ichi Noto, Yasunori Sato, Yukari Sekiguchi, Yuta Iwai, Satsuki Mitsuma, Minako Beppu, Keisuke Watanabe, Yumi Fujimaki, Yukiko Tsuji, Toshio Shimizu, Toshiki Mizuno, Masanori Nakagawa, Kyoko Sawaguchi, Hideki Hanaoka, Satoshi Kuwabara

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)

Abstract

Fasciculations are characteristic features of amyotrophic lateral sclerosis (ALS), and suggest motor nerve hyperexcitability. Recent reports have shown that an increase in persistent nodal sodium current is associated with shorter survival in ALS patients. This objective of this trial is to study the efficacy and safety of mexiletine, a sodium channel blocker, for ALS. Sixty eligible participants were randomly allocated (1:1) to riluzole 100 mg or riluzole plus mexiletine 300 mg. The primary endpoint was change in the revised ALS functional rating scale (ALSFRS-R) scores during six months. We also monitored strength-duration time constant (SDTC, a measure of persistent sodium current) in median motor axons. Results showed that during six months of treatment, changes in the ALSFRS-R score and SDTC were -7.0 ± 7.1 and -0.04 ± 0.1, respectively, in the riluzole group and -6.9 ± 6.4 and 0.04 ± 0.1, respectively, in the mexiletine group (p = 0.96 and 0.049). Adverse events amounted 20% in the riluzole and 33% in the mexiletine groups. In conclusion, the results suggest that daily 300 mg mexiletine has no effects on axonal sodium current and ALSFRS-R deterioration in ALS. We have to attempt another trial using a higher dose of mexiletine or other agents to suppress sodium currents and ALS progression in the future.

Original languageEnglish
Pages (from-to)353-358
Number of pages6
JournalAmyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Volume16
Issue number5-6
DOIs
Publication statusPublished - 2015 Aug 27
Externally publishedYes

Keywords

  • Mexiletine
  • amyotrophic lateral sclerosis
  • clinical trial
  • nerve excitability
  • sodium current

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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