4-Aminopyridine is superior to 3,4-diaminopyridine in the treatment of patients with multiple sclerosis.
OBJECTIVE
To compare the efficacy and toxicity of 4-aminopyridine and 3,4-diaminopyridine in patients with multiple sclerosis.


METHODS
Intervention study with a before-after design and a randomized, double-blind, crossover design.


METHODS
University referral center.


METHODS
Twenty-four patients with definite multiple sclerosis who had been treated in a previous clinical trial with 4-aminopyridine.


METHODS
Nonresponders to treatment with 4-aminopyridine (14 patients) were treated with 3,4-diaminopyridine in a 4-week, open-label trial with doses up to 1.0 mg/kg of body weight (before-after design). Responders to treatment with 4-aminopyridine (10 patients) participated in a comparative study of 6 weeks' duration with 4-aminopyridine and 3,4-diaminopyridine according to a randomized, double-blind, double-crossover design.


METHODS
Neurophysiologic variables for nonresponders, neurologic functions and symptoms on a visual analogue scale for responders, and side effects for both groups.


RESULTS
Toxicity profiles of 4-aminopyridine and 3,4-diaminopyridine were different, and systemic tolerability was reduced for 3,4-diaminopyridine. 4-Aminopyridine was more effective than 3,4-diaminopyridine, especially for ambulation, fatigue, and overall daily functioning.


CONCLUSIONS
Our data suggest that, concerning both efficacy and side effects, 4-aminopyridine is superior to 3,4-diaminopyridine in the treatment of patients with multiple sclerosis.
Polman
C H
CH
Department of Neurology, Free University Hospital, Amsterdam, The Netherlands.
Bertelsmann
F W
FW
de Waal
R
R
van Diemen
H A
HA
Uitdehaag
B M
BM
van Loenen
A C
AC
Koetsier
J C
JC
D015761:4-Aminopyridine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000077770:Amifampridine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D010919:Placebos
D010919:Placebos; D015761:4-Aminopyridine; D000077770:Amifampridine