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Impact of extended-release dalfampridine on walking ability in patients with multiple sclerosis

Authors Hayes KC

Published 28 April 2011 Volume 2011:7(1) Pages 229—239

DOI https://doi.org/10.2147/NDT.S10469

Review by Single-blind

Peer reviewer comments 3

Keith C Hayes
Department of Physical Medicine and Rehabilitation, The University of Western Ontario, London, ON, Canada

Abstract: Dalfampridine extended release (ER) 10 mg is an oral tablet form of the potassium (K+) channel-blocking compounded dalfampridine, also known as fampridine, and chemically 4-aminopyridine or 4-AP, which received regulatory approval in the United States for the treatment of walking in patients with multiple sclerosis (MS) in January 2010. Two pivotal Phase 3 clinical trials demonstrated significant improvements in walking in patients with the four primary forms of MS following administration of dalfampridine ER tablets 10 mg twice daily. The drug is thought to act by restoring conduction in focally demyelinated axons and by enhancing neurotransmission, thereby leading to improved neurological function. This review describes how dalfampridine represents a new pharmacotherapeutic approach to the clinical management of mobility impairment. It describes the mechanism of action and chemistry of dalfampridine ER, its pharmacokinetics, tolerability, and side effects, and the outcomes of multicenter trials showing its efficacy in improving walking speed. Clinician and patient global assessments, as well as patient self-assessment of the impact of MS on their gait disability, confirm clinically relevant benefit from the therapy. Patients tolerate the drug well and their improvement in terms of household and community ambulation, inferred from analysis of pooled data from several studies, is likely to translate into benefits in the performance of instrumental activities of daily living and a reduction in the neuropsychiatric burden of disease.

Keywords: dalfampridine ER, Ampyra®, fampridine-SR, 4-aminopyridine, multiple sclerosis, demyelination

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