Erythropoietin in amyotrophic lateral sclerosis: a multicentre, randomised, double blind, placebo controlled, phase III study.
OBJECTIVE
To assess the efficacy of recombinant human erythropoietin (rhEPO) in amyotrophic lateral sclerosis (ALS).


METHODS
Patients 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.


RESULTS
We 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.


CONCLUSIONS
RhEPO 40,000 IU fortnightly did not change the course of ALS.
['Lauria|Giuseppe|G|', 'Dalla Bella|Eleonora|E|', 'Antonini|Giovanni|G|', 'Borghero|Giuseppe|G|', 'Capasso|Margherita|M|', 'Caponnetto|Claudia|C|', 'Chiò|Adriano|A|', 'Corbo|Massimo|M|', 'Eleopra|Roberto|R|', 'Fazio|Raffaella|R|', 'Filosto|Massimiliano|M|', 'Giannini|Fabio|F|', 'Granieri|Enrico|E|', 'La Bella|Vincenzo|V|', 'Logroscino|Giancarlo|G|', 'Mandrioli|Jessica|J|', 'Mazzini|Letizia|L|', 'Monsurrò|Maria Rosaria|MR|', 'Mora|Gabriele|G|', 'Pietrini|Vladimiro|V|', 'Quatrale|Rocco|R|', 'Rizzi|Romana|R|', 'Salvi|Fabrizio|F|', 'Siciliano|Gabriele|G|', 'Sorarù|Gianni|G|', 'Volanti|Paolo|P|', 'Tramacere|Irene|I|', 'Filippini|Graziella|G|', '|||']
D000328:Adult D000368:Aged D000690:Amyotrophic Lateral Sclerosis D004311:Double-Blind Method D000068817:Epoetin Alfa D004921:Erythropoietin D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011994:Recombinant Proteins D016896:Treatment Outcome
ALS MOTOR NEURON DISEASE