• Ryuji Kaji, Takashi Imai, Yasuo Iwasaki, Koichi Okamoto, Masanori Nakagawa, Yasuo Ohashi, Takao Takase, Takahisa Hanada, Hiroki Shimizu, Kunio Tashiro, and Shigeki Kuzuhara.
• Department of Neurology, Tokushima University Hospital, Tokushima, Japan rkaji@tokushima-u.ac.jp.
• J. Neurol. Neurosurg. Psychiatr. 2019 Apr 1; 90 (4): 451-457.

ObjectiveTo evaluate the efficacy and safety of intramuscular ultra-high-dose methylcobalamin in patients with amyotrophic lateral sclerosis (ALS).Methods373 patients with ALS (El Escorial definite or probable; laboratory-supported probable; duration ≤36 months) were randomly assigned to placebo, 25 mg or 50 mg of methylcobalamin groups. The primary endpoints were the time interval to primary events (death or full ventilation support) and changes in the Revised ALS Functional Rating Scale (ALSFRS-R) score from baseline to week 182. Efficacy was also evaluated using post-hoc analyses in patients diagnosed early (entered ≤12 months after symptom onset).ResultsNo significant differences were detected in either primary endpoint (minimal p value=0.087). However, post-hoc analyses of methylcobalamin-treated patients diagnosed and entered early (≤12 months' duration) showed longer time intervals to the primary event (p<0.025) and less decreases in the ALSFRS-R score (p<0.025) than the placebo group. The incidence of treatment-related adverse events was similar and low in all groups.ConclusionAlthough ultra-high-dose methylcobalamin did not show significant efficacy in the whole cohort, this treatment may prolong survival and retard symptomatic progression without major side effects if started early.Trial Registration NumberNCT00444613.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

17 keywords...

hide…