• Giuseppe Lauria, Eleonora Dalla Bella, Giovanni Antonini, Giuseppe Borghero, Margherita Capasso, Claudia Caponnetto, Adriano Chiò, Massimo Corbo, Roberto Eleopra, Raffaella Fazio, Massimiliano Filosto, Fabio Giannini, Enrico Granieri, Vincenzo La Bella, Giancarlo Logroscino, Jessica Mandrioli, Letizia Mazzini, Maria Rosaria Monsurrò, Gabriele Mora, Vladimiro Pietrini, Rocco Quatrale, Romana Rizzi, Fabrizio Salvi, Gabriele Siciliano, Gianni Sorarù, Paolo Volanti, Irene Tramacere, Graziella Filippini, and EPOS Trial Study Group.
• Neuromuscular Disease, IRCCS Foundation, "Carlo Besta" Neurological Institute, Milan, Italy.
• J. Neurol. Neurosurg. Psychiatr. 2015 Aug 1;86(8):879-86.

ObjectiveTo assess the efficacy of recombinant human erythropoietin (rhEPO) in amyotrophic lateral sclerosis (ALS).MethodsPatients with probable laboratory-supported, probable or definite ALS were enrolled by 25 Italian centres and randomly assigned (1:1) to receive intravenous rhEPO 40,000 IU or placebo fortnightly as add-on treatment to riluzole 100 mg daily for 12 months. The primary composite outcome was survival, tracheotomy or >23 h non-invasive ventilation (NIV). Secondary outcomes were ALSFRS-R, slow vital capacity (sVC) and quality of life (ALSAQ-40) decline. Tolerability was evaluated analysing adverse events (AEs) causing withdrawal. The randomisation sequence was computer-generated by blocks, stratified by centre, disease severity (ALSFRS-R cut-off score of 33) and onset (spinal or bulbar). The main outcome analysis was performed in all randomised patients and by intention-to-treat for the entire population and patients stratified by severity and onset. The study is registered, EudraCT 2009-016066-91.ResultsWe randomly assigned 208 patients, of whom 5 (1 rhEPO and 4 placebo) withdrew consent and 3 (placebo) became ineligible (retinal thrombosis, respiratory insufficiency, SOD1 mutation) before receiving treatment; 103 receiving rhEPO and 97 placebo were eligible for analysis. At 12 months, the annualised rate of death (rhEPO 0.11, 95% CI 0.06 to 0.20; placebo: 0.08, CI 0.04 to 0.17), tracheotomy or >23 h NIV (rhEPO 0.16, CI 0.10 to 0.27; placebo 0.18, CI 0.11 to 0.30) did not differ between groups, also after stratification by onset and ALSFRS-R at baseline. Withdrawal due to AE was 16.5% in rhEPO and 8.3% in placebo. No differences were found for secondary outcomes.ConclusionsRhEPO 40,000 IU fortnightly did not change the course of ALS.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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