Treatment of ALS

No cure has yet been found for ALS. However, there are some treatments available to help relieve symptoms and improve the quality of life for people with ALS. There is also an FDA-approved therapy proven to extend survival of patients with ALS. Research is continuing to find the cause(s) of ALS, understand the mechanisms involved in disease progression, and develop other effective treatments.

Relief of Symptoms

Medication and other supportive measures may be necessary to relieve ALS-related symptoms,^1,2,3 such as:

depression, anxiety, and insomnia
shortness of breath
excessive saliva or drooling
muscle spasms, stiffness
emotional lability
weight loss, malnutrition
constipation
urinary urgency or frequency

ALS Therapies

Rilutek

Rilutek has been proven to extend survival time to tracheostomy or death, and is the only medication currently approved by the U.S. Food and Drug Administration for the treatment of ALS.⁴

Rilutek has been used by neurologists and other physicians to treat ALS patients for more than 10 years. ⁵

Additional Therapies

As ALS progresses and muscles weaken, patients may benefit from rehabilitation services to enhance independence and maintain safety, such as:²

Physical therapy -to strengthen muscles, improve cardiovascular health, and fight fatigue.
Occupational therapy -to maintain performance of daily tasks.
Speech therapy -because ALS affects the muscles used to speak and swallow.
Assistive devices-such as braces, canes, walkers, wheelchairs and communication devices.
Nutritional support -advice on foods that are nutritious and easy to swallow; gastrostomy tube leadings.
Emotional support -utilizing medication and counseling if a patient becomes anxious or depressed.²
Respiratory support -non invasive (BiPAP) or invasive (tracheostomy) mechanical ventilation.

Important Treatment Considerations

Evaluate serum ALT levels every month during the first 3 months of treatment, and every 3 months during the remainder of the first year. Thereafter, serum ALT levels should be periodically evaluated more frequently in patients who develop elevations. Rilutek should be discontinued if ALT levels increase to 5 times ULN or if clinical jaundice develops.
Advise patients about the potential for dizziness, vertigo, or somnolence and not to drive or operate machinery until they have sufficient experience on Rilutek.
Advise patients to report any febrile illness; measure WBCs.
Use Rilutek with caution in patients with concomitant liver insufficiency; caution should be exercised when prescribing Rilutek to patients taking drugs that are potentially hepatotoxic or highly protein bound:
- Interactions may also occur when riluzole is given concurrently with agents that affect hepatic CYP 1A2 activity.^*

*CYP 1A2 is the principal isoenzyme involved in the initial oxidative metabolism of riluzole. CYP 1A2 inhibitors, such as amitriptyline, caffeine, phenacetin, theophylline, or quinolones, may potentially decrease the rate of riluzole elimination. CYP 1A2 inducers, such as cigarette smoke, charcoal-broiled food, rifampicin, or omeprazole, may potentially increase the rate of elimination.

The health information contained herein is provided for general educational purposes only. As a healthcare professional, you are the single best source of information regarding healthcare for your patients with ALS. Please contact sanofi-aventis if you have any questions or need more information about treating ALS.

References

Medical Encyclopedia: Amyotrophic lateral sclerosis. Medline Plus website. Available at http://nlm.nih.gov/medlineplus/print/ency/article/000688.htm. Accessed May 11, 2007.
Treatment Options for Lou Gehrig’s Disease. Mayo Clinic website. Available at http://mayoclinic.org/lou-gehrigs-disease/treatment.html. Accessed May 11, 2007.
NINDS Amyotrophic Lateral Sclerosis Information Page. National Institute of Neurological Disorders and Stroke website. Available at http://ninds.nih.gov/disorders/amyotrophiclateralsclerosis. Accessed May 23, 2007.
Facts About Amyotrophic Lateral Sclerosis (ALS). Muscular Dystrophy Association, ALS Division website. Available at http://als-mda.org/publications/fa-als.html. Accessed May 23, 2007.
Facts you should know about ALS. The ALS Association website. Available at http://www.alsa.org/als/what.cfm?CFID=3664013&CFTOKEN=28694482. Accessed May 23, 2007.
Regular Use of Vitamin E Supplements Linked to Reduced Risk of Death from ALS (amyotrophic lateral sclerosis). Harvard School of Public Health website. Available at http://www.hsph.harvard.edu/press/releases/press12172004.html.