Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine

A randomized trial

B. R. Brooks, R. A. Thisted, S. H. Appel, Walter G Bradley, R. K. Olney, J. E. Berg, L. E. Pope, R. A. Smith

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Background: Patients with ALS commonly exhibit pseudobulbar affect. Methods: The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its components. Patients were evaluated on days 1, 15, and 29. The primary efficacy variable was the change from baseline in the Center for Neurologic Study Lability Scale (CNS-LS) score. Secondary efficacy variables were laughing/crying episode rates and changes in Visual Analog Scales for Quality of Life (QOL) and Relationships (QOR). Efficacy was evaluated in intention-to-treat subjects who were not poor metabolizers of DM (n = 65 for AVP-923, n = 30 for DM, and n = 34 for Q). Safety was assessed in all randomized subjects (n = 140). Results: AVP-923 patients experienced 3.3-point greater improvements in CNS-LS than DM patients (p = 0.001) and 3.7-point greater improvements than Q patients (p < 0.001). AVP-923 patients exhibited lower overall episode rates, improved QOL scores, and improved QOR scores (p < 0.01 for all endpoints). Adverse effects were mostly mild or moderate; treatment-related discontinuation was 24% for AVP-923, 6% for DM, and 8% for Q. Conclusions: AVP-923 palliates pseudobulbar affect in ALS. Overall benefits of treatment are reflected in fewer episodes of crying and laughing and improvements in overall quality of life and quality of relationships.

Original languageEnglish
Pages (from-to)1364-1370
Number of pages7
JournalNeurology
Volume63
Issue number8
StatePublished - Oct 26 2004

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Dextromethorphan
Quinidine
Quality of Life
Crying
Nervous System
Therapeutics
dextromethorphan - quinidine combination
Visual Analog Scale
Safety

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Brooks, B. R., Thisted, R. A., Appel, S. H., Bradley, W. G., Olney, R. K., Berg, J. E., ... Smith, R. A. (2004). Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: A randomized trial. Neurology, 63(8), 1364-1370.

Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine : A randomized trial. / Brooks, B. R.; Thisted, R. A.; Appel, S. H.; Bradley, Walter G; Olney, R. K.; Berg, J. E.; Pope, L. E.; Smith, R. A.

In: Neurology, Vol. 63, No. 8, 26.10.2004, p. 1364-1370.

Research output: Contribution to journalArticle

Brooks, BR, Thisted, RA, Appel, SH, Bradley, WG, Olney, RK, Berg, JE, Pope, LE & Smith, RA 2004, 'Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: A randomized trial', Neurology, vol. 63, no. 8, pp. 1364-1370.
Brooks BR, Thisted RA, Appel SH, Bradley WG, Olney RK, Berg JE et al. Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: A randomized trial. Neurology. 2004 Oct 26;63(8):1364-1370.
Brooks, B. R. ; Thisted, R. A. ; Appel, S. H. ; Bradley, Walter G ; Olney, R. K. ; Berg, J. E. ; Pope, L. E. ; Smith, R. A. / Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine : A randomized trial. In: Neurology. 2004 ; Vol. 63, No. 8. pp. 1364-1370.
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abstract = "Background: Patients with ALS commonly exhibit pseudobulbar affect. Methods: The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its components. Patients were evaluated on days 1, 15, and 29. The primary efficacy variable was the change from baseline in the Center for Neurologic Study Lability Scale (CNS-LS) score. Secondary efficacy variables were laughing/crying episode rates and changes in Visual Analog Scales for Quality of Life (QOL) and Relationships (QOR). Efficacy was evaluated in intention-to-treat subjects who were not poor metabolizers of DM (n = 65 for AVP-923, n = 30 for DM, and n = 34 for Q). Safety was assessed in all randomized subjects (n = 140). Results: AVP-923 patients experienced 3.3-point greater improvements in CNS-LS than DM patients (p = 0.001) and 3.7-point greater improvements than Q patients (p < 0.001). AVP-923 patients exhibited lower overall episode rates, improved QOL scores, and improved QOR scores (p < 0.01 for all endpoints). Adverse effects were mostly mild or moderate; treatment-related discontinuation was 24{\%} for AVP-923, 6{\%} for DM, and 8{\%} for Q. Conclusions: AVP-923 palliates pseudobulbar affect in ALS. Overall benefits of treatment are reflected in fewer episodes of crying and laughing and improvements in overall quality of life and quality of relationships.",
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T2 - A randomized trial

AU - Brooks, B. R.

AU - Thisted, R. A.

AU - Appel, S. H.

AU - Bradley, Walter G

AU - Olney, R. K.

AU - Berg, J. E.

AU - Pope, L. E.

AU - Smith, R. A.

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N2 - Background: Patients with ALS commonly exhibit pseudobulbar affect. Methods: The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its components. Patients were evaluated on days 1, 15, and 29. The primary efficacy variable was the change from baseline in the Center for Neurologic Study Lability Scale (CNS-LS) score. Secondary efficacy variables were laughing/crying episode rates and changes in Visual Analog Scales for Quality of Life (QOL) and Relationships (QOR). Efficacy was evaluated in intention-to-treat subjects who were not poor metabolizers of DM (n = 65 for AVP-923, n = 30 for DM, and n = 34 for Q). Safety was assessed in all randomized subjects (n = 140). Results: AVP-923 patients experienced 3.3-point greater improvements in CNS-LS than DM patients (p = 0.001) and 3.7-point greater improvements than Q patients (p < 0.001). AVP-923 patients exhibited lower overall episode rates, improved QOL scores, and improved QOR scores (p < 0.01 for all endpoints). Adverse effects were mostly mild or moderate; treatment-related discontinuation was 24% for AVP-923, 6% for DM, and 8% for Q. Conclusions: AVP-923 palliates pseudobulbar affect in ALS. Overall benefits of treatment are reflected in fewer episodes of crying and laughing and improvements in overall quality of life and quality of relationships.

AB - Background: Patients with ALS commonly exhibit pseudobulbar affect. Methods: The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its components. Patients were evaluated on days 1, 15, and 29. The primary efficacy variable was the change from baseline in the Center for Neurologic Study Lability Scale (CNS-LS) score. Secondary efficacy variables were laughing/crying episode rates and changes in Visual Analog Scales for Quality of Life (QOL) and Relationships (QOR). Efficacy was evaluated in intention-to-treat subjects who were not poor metabolizers of DM (n = 65 for AVP-923, n = 30 for DM, and n = 34 for Q). Safety was assessed in all randomized subjects (n = 140). Results: AVP-923 patients experienced 3.3-point greater improvements in CNS-LS than DM patients (p = 0.001) and 3.7-point greater improvements than Q patients (p < 0.001). AVP-923 patients exhibited lower overall episode rates, improved QOL scores, and improved QOR scores (p < 0.01 for all endpoints). Adverse effects were mostly mild or moderate; treatment-related discontinuation was 24% for AVP-923, 6% for DM, and 8% for Q. Conclusions: AVP-923 palliates pseudobulbar affect in ALS. Overall benefits of treatment are reflected in fewer episodes of crying and laughing and improvements in overall quality of life and quality of relationships.

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