​Fampyra (Fampridine): Enhancing Mobility In Multiple Sclerosis Patients

Fampyra, known generically as fampridine or 4-aminopyridine, is an oral medication approved to improve walking ability in adults with multiple sclerosis (MS) who experience walking disabilities.

It functions as a potassium channel blocker, aiming to enhance nerve signal conduction in demyelinated nerves characteristic of MS.​

Mechanism Of Action

In MS, the protective myelin sheath surrounding nerve fibers is damaged, leading to impaired nerve signal transmission. Fampridine works by blocking potassium channels on the surface of nerve fibers, which may help restore conduction and improve motor function.​

Clinical Efficacy

Clinical trials have demonstrated that fampridine can lead to significant improvements in walking speed and mobility for some MS patients. Approximately 30% of patients treated with fampridine showed a measurable improvement in walking speed compared to placebo.

These benefits have been observed to persist over extended periods, with some studies reporting sustained improvements for up to five years.​

​Fampyra Research

There have been a number of clinical trials of fampridine.

For example, a phase III study involving 301 people with relapsing or progressive MS who were treated for 14 weeks, showed a greater proportion of people taking fampridine had a consistent improvement in walking speed compared to people taking placebo (35% v 8%).

This improvement was maintained for the duration of the study.

A review of a wide range of clinical trials by NICE, completed as part of the development of the 2014 MS Clinical Guideline, concluded that fampridine had a positive effect on walking speed compared with placebo.

However, there was little good evidence for an appreciable effect on EDSS, a commonly used measure of disability.

In 2019, the ENHANCE trial of fampridine reported a clinically meaningful improvement in walking ability (not just speed) in patients who had taken fampridine, compared to placebo. This study included 636 adults with MS who had an EDSS between 4 and 7.

Fampyra Safety And Side Effects

Common side effects associated with fampridine include urinary tract infections, insomnia, dizziness, headache, nausea, and back pain.

A significant concern is the increased risk of seizures, particularly at higher doses or in patients with renal impairment. Therefore, fampridine is contraindicated in individuals with a history of seizures or moderate to severe renal dysfunction.​

Low Clinical Benefit In The Management Of Walking Disorders

It failed to improve the quality of life of the patients in the clinical studies.

FAMPYRA has been granted a marketing authorisation for the improvement in walking ability of patients suffering from multiple sclerosis (MS) and presenting with a walking handicap (EDSS 4-7).

The data derived from a new phase III study have confirmed its modest efficacy versus placebo on walking ability, along with the existence of a small fraction of responders that cannot be identified beforehand.

Its tolerance profile is marked by high, though relatively infrequent risks of convulsions, severe hypersensitivity and urinary tract infection.

Conclusion

Fampridine offers a valuable treatment option for MS patients experiencing walking difficulties, providing potential improvements in mobility and quality of life.

However, due to the risk of serious side effects like seizures, careful patient selection and monitoring are essential. Ongoing research continues to explore the broader benefits of fampridine, including its impact on cognitive functions.

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