title: Perhexiline maleate in the treatment of fibrodysplasia ossificans progressiva: an open-labeled clinical trial.
abstract: BACKGROUND
  Currently, there are no effective medical treatment options to prevent the formation of heterotopic bones in fibrodysplasia ossificans progressiva (FOP). By the drug repositioning strategy, we confirmed that perhexiline maleate (Pex) potentially ameliorates heterotopic ossification in model cells and mice. Here, we conducted a prospective study to assess the efficacy and safety of Pex in the treatment of FOP patients.
  
  
  METHODS
  FOP patients in this open-label single-center study were treated with Pex for a total of 12 months, and followed up for 12 consecutive months after medication discontinuation. The safety of the treatment was assessed regularly by physical and blood examinations. The efficacy of Pex for preventing heterotopic ossifications was evaluated by the presence of flare-ups, measurements of serum bone markers, and changes in the total bone volume calculated by the three-dimensional computed tomography (3D-CT) images.
  
  
  RESULTS
  Five patients with an average age of 23.4 years were enrolled. Within safe doses of Pex administration in each individual, there were no drug-induced adverse effects during the medication phase. Three patients showed no intense inflammatory reactions during the study period, while two patients had acute flare-ups around the hip joint without evidence of trauma during the medication phase. In addition, one of them became progressively incapable of opening her mouth over the discontinuation phase. Serum levels of alkaline phosphatase (ALP) and bone specific ALP (BAP) were significantly and synchronously increased with the occurrence of flare-ups. Volumetric 3D-CT analysis demonstrated a significant increase in the total bone volume of Case 2 (378 cm(3)) and Case 3 (833 cm(3)) during the two-year study period.
  
  
  CONCLUSIONS
  We could not prove the efficacy of oral Pex administration in the prevention of heterotopic ossifications in FOP. Serum levels of ALP and BAP appear to be promising biomarkers for monitoring the development of ectopic ossifications and efficacy of the therapy. Quantification of change in the total bone volume by whole body CT scanning could be a reliable evaluation tool for disease progression in forthcoming clinical trials of FOP.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan. hkitoh@med.nagoya-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitoh
authors.forename: Masataka
authors.initials: M
authors.lastname: Achiwa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Kenichi
authors.initials: K
authors.lastname: Mishima
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsushita
authors.forename: Izumi
authors.initials: I
authors.lastname: Kadono
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
authors.forename: Benedetta C
authors.initials: BC
authors.lastname: Sallustio
authors.forename: Kinji
authors.initials: K
authors.lastname: Ohno
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D009221:Myositis Ossificans / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015675:Osteocalcin / Q000097:blood; D010480:Perhexiline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011859:Radiography; D055815:Young Adult
chemical_list: D015675:Osteocalcin; D000469:Alkaline Phosphatase; C023470:perhexiline maleate; D010480:Perhexiline