Riluzole may benefit patients with degenerative cervical myelopathy
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Although patients with degenerative cervical myelopathy are mainly treated with surgery, patients saw improvement in arm and neck pain when treated with riluzole, a drug typically used in patients with amyotrophic lateral sclerosis.
In a plenary session at the North American Spine Society Annual Meeting, which was held as a virtual meeting, Michael G. Fehlings, MD, PhD, FRCSC, of Toronto, discussed key knowledge gaps and areas that can benefit from more research focused on degenerative cervical myelopathy (DCM).
He also presented results of the recently completed Cervical Spondylotic Myelopathy (CSM)-Protect study into the efficacy of riluzole, which is a sodium glutamate antagonist.
“There is good basic science evidence to indicate that riluzole improves outcomes in animal models of DCM, reduces ischemia perfusion injury perioperatively and also attenuates neuropathic pain. So, based on this, we embarked on the CSM Protect trial,” Fehlings said.
Investigators at 16 centers treated 300 patients who were randomized to receive either riluzole or placebo at 2 weeks preoperative to DCM surgery and at 4 weeks postoperatively.
The primary outcome was improvement in the modified Japanese Orthopaedic Association (mJOA) score, which is used to rate myelopathy severity.
Although the complications were similar for patients in both groups, “Unfortunately, the mJOA score was not sensitive enough to detect neurological changes with riluzole. So, we saw no effect, so the primary outcome was not positive,” Fehlings said.
However, in results for planned secondary outcomes of neck and arm pain, which Fehlings said “is a significant issue in many patients, ... we did see a significant improvement in the VAS improvements in neck and arms pain with riluzole.”
The drug was also well tolerated, he said.
“We would suggest that potentially looking at riluzole might be of clinical interest to physicians, perhaps trying a longer duration of treatment, maybe focusing on patients who come in with neuropathic pain. There is an opportunity to look at more sensitive outcome measures,” Fehlings said.
Reference:
https://clinicaltrials.gov/ct2/show/NCT01257828
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Fehlings MG. DCM: The global burden and need for knowledge discovery. Presented during: Advances and challenges in degenerative cervical myelopathy at: North American Spine Society Annual Meeting; Oct. 6-9, 2020 (virtual meeting).
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