Edaravone (Radicava) approved to treat MND in USA – what does this mean for people with MND in the UK

On Friday 5 May in America, the FDA, the organisation that approves drugs, announced that they’d granted a licence for the drug known as a Edaravone (to be marketed as Radicava ) for the treatment of MND. It’s extremely exciting news and we’re currently working out what this means for people with MND in the UK. Below is more information on what we know so far:

What is this drug and what does it do?
In clinical trials, Edaravone has been shown to slow the progression of MND potentially helping people preserve function longer. Some of the clinical trial results have shown that Edaravone only works on a subset of people at the early stages of the disease – we are seeking to confirm this.

Edaravone is an antioxidant drug that works by mopping up ‘free radicals’ in the body. Our cells have quite effective ways of dealing with free radicals, but these ‘cellular defences’ become less and less efficient with age.

As we age, our energy production processes lose efficiency, causing a ‘double-whammy’ of not only more free radicals being produced, but also less effective ways of dealing with them. When neurones are damaged, as happens with neurodegenerative diseases, then everything gets exacerbated even further, leading to a vicious cycle of events.

It’s a bit like sparks escaping from a campfire – if there are too many sparks and you don’t keep an eye on things, you could end up with the forest ablaze. There’s more information on earlier post on our research blog.

How would people take Edaravone?
Edaravone is administered intra-venously (IV). People with MND would receive the drug every day for two weeks, then take a break for two weeks. A company called Treeway are currently developing an oral preparation of the drug.

What is the process for licencing this in Europe?
We are in contact with Mitsibushi-Tanabe in the USA and have asked them to connect us with their European office in order to understand their plans for licensing in Europe.

The company will have to apply to the European Medicines Evaluation Agency. The drug has already been registered with EMEA as an orphan disease candidate, which means that any licensing application will be fast-tracked. EMEA approval, however, does not ensure UK approval and the drug would need to be approved by the Medicines and Healthcare Regulatory Agency. New medicines are usually also reviewed by the National Institute for health and Care Excellence, which makes recommendations on the cost-effectiveness to the NHS. There is a process for joint MHRA-NICE review which the company will doubtless pursue.

The licencing process does take time, so the company could also apply through the Government’s Early Access to Medicines scheme, which aims to make a drug available where marketing authorisation is not yet approved and there is a clear unmet medical need.

Where can I find out more?
More information on Edaravone is available on the ALS Association website. More information on clinical trials in general is available on our website our website and in our research information sheet. As we learn more about the developments of the drug we will keep everyone updated.

Prize winning posters in Dublin

As well as all the networking, debate and new information being shared, the International Symposium on ALS/MND is also a time to celebrate achievements by the giving of awards. The Biomedical and Clinical poster prizes are an opportunity to recognise and celebrate the excellent research and clinical practice being conducted by those early in their career.

Now in its fourth year we hope that the poster prizes will help give the winners career a boost, and give them the encouragement and motivation to continue in MND/ALS research.poster-prize-winners-low-res This year the Panel selected an international group of winners: Dr Albert Lee from Australia and Elsa Tremblay from Canada were jointly awarded the Biomedical poster prize and Ruben van Eijk from The Netherlands won the Clinical poster prize. Each winner received a certificate and a glass engraved paperweight.

The prize winning research ranged from understanding the consequences of a newly discovered gene mutation linked to MND, to why the junction between nerves and muscles is one of the earliest signs of motor neurone damage, to a new statistical analysis to make clinical trials quicker and more efficient. Below I’ve explained more about the research that the winners presented. Continue reading

ALS/MND Clinical Trial Guidelines: your opportunity to comment!

A few months ago we wrote an article about the ALS Clinical Trials Workshop which took place in Virginia, USA. Since then the Guidelines Working Groups have been busy turning the large number of issues debated into a first draft of a new set of guidelines. This is open for comment from 1- 31 August.

The guidelines will be posted on this website, and comments can be sent to guidelines.public.comments@gmail.com.

The guidelines are divided into sections:

  • Preclinical studies
  • Study design and biological and phenotypic heterogeneity
  • Outcome measures
  • Therapeutic / Symptomatic interventions in clinical trials
  • Patient recruitment and retention
  • Biomarkers
  • Different trial phases and beyond – (there are two sections on this)

Within each of these sections, there are many recommendations. The Clinical Trials Guidelines Investigators want to ensure that all interested people and stakeholders have an opportunity to provide input – whether you are a researcher, clinician or person with MND.

Thank you very much for your help.

For more information, please see a copy of their press release below: Continue reading

Correcting the early damage seen in MND

Previous research in humans and zebrafish has shown that before symptoms arise in MND, early changes occur in the interneurones. This type of nerve cell provide a link between the upper and lower motor neurones in the brain and spinal cord.

The job of one type of interneurone (called inhibitory interneurones) is to apply the brakes on motor neurones. They work just like brakes on a bike stop the wheels from moving.

The interneurones control when chemical signals/messages (or action potentials) can be passed along the nerve cell. In MND these brakes are less effective (so to use the bike analogy, the brakes might be rusty or not connected properly).

Interneurones are being studied in more detail in a project led by Dr Jonathan McDearmid (University of Leicester), in collaboration with Dr Tennore Ramesh and Prof Dame Pamela Shaw (Sheffield Institute for Translational Neuroscience) (our reference: 835-791). Continue reading

Protecting motor neurones against oxidative stress in MND

During the early stages of MND it is proposed that motor neurones are more susceptible to an imbalance of oxygen within the cells, known as oxidative stress. Prof Dame Kay Davies, at the University of Oxford, has previously shown that increasing the levels of the gene Oxr1 can protect motor neurones from death caused by oxidative stress and delay MND in mice. You can read about this work here. Continue reading

Flying towards an understanding of TDP-43

If you looked at the motor neurones of people with MND down the microscope you would see clumps of a protein called TDP-43. Researchers around the world are working to find why these clumps form and how they are linked to MND.

Dr Jemeen Sreedharan has been looking at the effects of TDP-43 in fruit flies. Initially he investigated how TDP-43 caused its effects, later moving on to find ways to reduce or prevent the damage. He spent the first two years of his MRC and MND Association-funded Fellowship (our reference: 943-795) working at the University of Massachusetts, Boston USA returning last autumn to perform the next stages of his research at the Babraham Institute near Cambridge, UK. Continue reading

Developing models to test new treatments for MND

Developing disease models is important for furthering our understanding of MND and allows researchers to screen potential new drugs for a beneficial effect. Moving a promising ‘nearly drug’ from the lab to being tested in people is known as ‘translational research’.

Dr Richard Mead

Dr Richard Mead

Dr Richard Mead was awarded the Kenneth Snowman/MND Association Lectureship in Translational Neuroscience in May 2014. The Lectureship is part funded by the MND Association (our reference 983-797).

We have recently received a progress report from Dr Mead. Its clear that his background and experience in this area – including several years working in the pharmaceutical industry – has helped him to rapidly develop a portfolio of projects and collaborations with academic and industry partners. Continue reading

Preventing TDP-43 deposits in motor neurones

Deposits of the protein TDP-43 are found within the motor neurones in the majority of cases of MND, and are considered a pathological hallmark of the disease. While we do not fully understand how these deposits are formed, previous research has shown that activation of a process called the Unfolded Protein Response (UPR) can cause TDP-43 protein to deposit in the motor neurones. Continue reading

Re-evaluating clinical trial guidelines for MND

To mark International Clinical Trials Day (20 May) we reflect on the ALS Clinical Trials Guidelines workshop that took place in March. The MND Association co-sponsored this successful meeting, held at Airlie House in Virginia USA. Approximately 140 delegates from across the world attended, including 11 MND researchers and doctors from the UK.

Why was this meeting held?

The meeting was a key stage in the process to update (and improve) international guidelines for clinical trials in amyotrophic lateral sclerosis (ALS, the most common form of MND).

The first international ALS clinical trials guideline workshop took place in 1998. The guidelines were designed to improve the quality of clinical trials in ALS, and provide evidence based recommendations to those designing and carrying out all stages of clinical trials. Continue reading

Stem cell trials in the news

The recent announcement about the use of stem cells to treat a form of multiple sclerosis (MS), together with early results from the BrainStorm stem cell amyotrophic lateral sclerosis (ALS) clinical trial in Israel have raised the profile of stem cells as a possible treatment for motor neurone disease.

Stem cells are unspecialised cells in the body which do not yet perform a particular function. They can renew themselves and have the ability to give rise to different types of cell, including nerve cells (motor neurones and the surrounding support cells).

Both the ALS/MND study (ALS is a type of motor neurone disease) and the MS study used stem cells found in bone marrow taken from the patient, and then given back to the same patient later on in the process. The MND study gave a new use to the bone marrow stem cells, whereas in the MS study ‘corrupt/damaged’ stem cells were replaced with a new healthier set.

Below we look at both trials in more detail and describe what they mean for people living with MND. Continue reading