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J Neurol Sci. 2016 Apr 15;363:69-76. doi: 10.1016/j.jns.2016.02.012. Epub 2016 Feb 6.

Efficacy and safety profile of memantine in patients with cognitive impairment in multiple sclerosis: A randomized, placebo-controlled study.

Author information

1
Department of Biostatistics and Clinical Research, Centre Hospitalier Universitaire de Caen, France.
2
Department of Neurology, Centre Hospitalier de Poissy, France.
3
Department of Neurology, Centre Hospitalier Régional et Universitaire de Strasbourg, France.
4
Department of Neurology, Centre Hospitalier Régional et Universitaire de Lille, France.
5
Department of Neurology, Centre Hospitalier Universitaire de Nîmes, France.
6
Department of Neurology, Centre Hospitalier de Fort-de-France, France.
7
Department of Neurology, Centre Hospitalier Universitaire de Nancy, France.
8
Department of Neurology, Centre Hospitalier Universitaire de Bordeaux, France.
9
Department of Neurology, Centre Hospitalier de Cherbourg, France.
10
Department of Neurology, Centre Hospitalier de Lorient, France.
11
Department of Neurology, Centre Hospitalier Universitaire de Clermont-Ferrand, France.
12
Department of Neurology, Centre Hospitalier Universitaire de Toulouse, France.
13
Department of Neurology, Centre Hospitalier Universitaire de Nice, France.
14
Department of Neurology, Centre Hospitalier Universitaire de Nantes, France.
15
Department of Neurology, Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France.
16
Department of Neurology, Assistance Publique des Hôpitaux de Paris, France.
17
Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, France.
18
Department of Neurology, Centre Hospitalier Universitaire de Reims, France.
19
Department of Neurology, Centre Hospitalier Universitaire de Caen, France; INSERM U 919, GIP Cyceron, Caen, France.

Abstract

Memantine, an uncompetitive antagonist of N-methyl-D-aspartate (NMDA)-type glutamate receptors that was approved for the treatment of moderate to severe Alzheimer's disease, has been negatively evaluated for the treatment of cognitive disorders of multiple sclerosis, but these studies were conducted only during short-term administration and on a heterogeneous group of patients with different forms of the disease. In addition, many adverse reactions were observed in these patients.

AIMS:

The purpose of the "EMERITE" (NCT01074619) study was to examine the efficacy and safety of the long-term administration of memantine as a symptomatic treatment for cognitive disorders in patients with relapsing-remitting multiple sclerosis (RR-MS).

METHODS:

The study was supported by the French Ministry of Health and received additional support from Lundbeck. In this double-blind, placebo-controlled, parallel group, randomized trial, the participants were assigned to receive memantine (20 mg/day) or a placebo for 52 weeks. The participants included males and females, 18-60 years of age, with a diagnosis of RR-MS and presenting with a cognitive complaint and/or demonstrating moderate cognitive impairment. The data were collected in the Department of Neurology in 19 French centers. The primary outcome was the Paced Auditory Serial Addition Test (PASAT) score at week 52. Secondary measurements included additional neuropsychological tests and the annualized relapse rate. The scores were adjusted according to the baseline scores in the analysis. The safety was assessed by the number of adverse events. The random sequence was generated using the Excel software. At each center, only the pharmacist had access to the allocation sequence and could be asked to unblind the trial.

RESULTS:

Fifty patients were allocated to the memantine group, and 43 to the placebo group. The intent-to-treat (ITT) population included 31 patients in each group. After adjusting for the PASAT scores at baseline, the PASAT scores at the end point did not differ between the memantine and the placebo groups (p=0.88). Adjusted mean score difference (memantine minus placebo), was -0.40 (95% confidence interval: -5.5; +4.7). No significant differences were observed for the secondary outcomes (short term memory and attention scores, EDSS, and relapse rate). The findings remained unchanged after multiple imputation of the missing values. Neurological and psychiatric adverse events were significantly higher in the memantine group than in the placebo group, and these parameters were higher than those reported in the product literature of memantine.

CONCLUSIONS:

No differences between the placebo and memantine groups were observed. Nevertheless, the tolerability of memantine was significantly worse than expected.

KEYWORDS:

Clinical trial; Cognitive disorders; Cognitive impairment; Memantine; Multiple sclerosis; PASAT; Patient safety; Placebo-controlled; Randomized; Test of Attentional Performance

PMID:
27000224
DOI:
10.1016/j.jns.2016.02.012
[Indexed for MEDLINE]

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