Open-label riluzole in fragile X syndrome

Craig A. Erickson, Ning Weng, Ivan Jeanne Weiler, William T. Greenough, Kimberly A. Stigler, Logan K. Wink, Christopher J. McDougle

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective. Glutamatergic dysregulation is implicated in the pathophysiology of fragile X syndrome (FXS). Riluzole is hypothesized to have an inhibitory effect on glutamate release, block excitotoxic effects of glutamate, and potentiate postsynaptic GABA(A) receptor function. Extracellular signal-related kinase (ERK) activation is known to be delayed in humans with FXS and knockout animal models of FXS. Correction of delayed ERK activation is a potential biomarker of treatment response in FXS. We conducted a six-week open-label prospective pilot study of riluzole (100 mg/day) in six adults with FXS. Methods. Riluzole was started at 50 mg every evening and then increased to 50 mg twice daily at week 2. The dose was kept constant for the final 4 weeks of the trial. Clinical response was determined by a score of 1 "very much improved" or 2 "much improved" on the Clinical Global Impressions Improvement (CGI-I) scale and a≥25% improvement on the Children's Yale-Brown Obsessive Compulsive Scale modified for Pervasive Developmental Disorders. The primary target of treatment in this study was repetitive, compulsive behavior that commonly occurs in persons with FXS. The study incorporated an ERK activation biomarker assay. Potential adverse effects were assessed in a systematic manner at all clinic visits and by phone between visits. Results. Riluzole treatment was associated with clinical response in 1 of 6 subjects (17%). Among a number of secondary outcome measures employed, significant improvement was only noted on the ADHD Rating Scale-IV (became non-significant when corrected for multiple comparisons). Riluzole use was associated with significant correction in ERK activation time in all subjects (mean change from 3.82 ± 0.27 (baseline) to 2.99 ± 0.26 (endpoint) minutes; p = 0.007). Riluzole was well tolerated; mean increases in liver function tests occurred but drug discontinuation was not required. Conclusion. Overall, riluzole use was not associated with significant clinical improvement despite uniform correction of peripheral ERK activation. Future directions of study include testing of riluzole in animal models of FXS and assessment of psychotropic monotherapy on ERK activation.

Original languageEnglish
Pages (from-to)264-270
Number of pages7
JournalBrain Research
Volume1380
DOIs
StatePublished - Mar 22 2011

Fingerprint

Riluzole
Fragile X Syndrome
Phosphotransferases
Glutamic Acid
Animal Models
Biomarkers
Compulsive Behavior
Liver Function Tests
GABA-A Receptors
Ambulatory Care
Therapeutics
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • ERK
  • Fragile X syndrome
  • Riluzole

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology
  • Developmental Biology
  • Molecular Biology

Cite this

Erickson, C. A., Weng, N., Weiler, I. J., Greenough, W. T., Stigler, K. A., Wink, L. K., & McDougle, C. J. (2011). Open-label riluzole in fragile X syndrome. Brain Research, 1380, 264-270. https://doi.org/10.1016/j.brainres.2010.10.108

Open-label riluzole in fragile X syndrome. / Erickson, Craig A.; Weng, Ning; Weiler, Ivan Jeanne; Greenough, William T.; Stigler, Kimberly A.; Wink, Logan K.; McDougle, Christopher J.

In: Brain Research, Vol. 1380, 22.03.2011, p. 264-270.

Research output: Contribution to journalArticle

Erickson, CA, Weng, N, Weiler, IJ, Greenough, WT, Stigler, KA, Wink, LK & McDougle, CJ 2011, 'Open-label riluzole in fragile X syndrome', Brain Research, vol. 1380, pp. 264-270. https://doi.org/10.1016/j.brainres.2010.10.108
Erickson CA, Weng N, Weiler IJ, Greenough WT, Stigler KA, Wink LK et al. Open-label riluzole in fragile X syndrome. Brain Research. 2011 Mar 22;1380:264-270. https://doi.org/10.1016/j.brainres.2010.10.108
Erickson, Craig A. ; Weng, Ning ; Weiler, Ivan Jeanne ; Greenough, William T. ; Stigler, Kimberly A. ; Wink, Logan K. ; McDougle, Christopher J. / Open-label riluzole in fragile X syndrome. In: Brain Research. 2011 ; Vol. 1380. pp. 264-270.
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N2 - Objective. Glutamatergic dysregulation is implicated in the pathophysiology of fragile X syndrome (FXS). Riluzole is hypothesized to have an inhibitory effect on glutamate release, block excitotoxic effects of glutamate, and potentiate postsynaptic GABA(A) receptor function. Extracellular signal-related kinase (ERK) activation is known to be delayed in humans with FXS and knockout animal models of FXS. Correction of delayed ERK activation is a potential biomarker of treatment response in FXS. We conducted a six-week open-label prospective pilot study of riluzole (100 mg/day) in six adults with FXS. Methods. Riluzole was started at 50 mg every evening and then increased to 50 mg twice daily at week 2. The dose was kept constant for the final 4 weeks of the trial. Clinical response was determined by a score of 1 "very much improved" or 2 "much improved" on the Clinical Global Impressions Improvement (CGI-I) scale and a≥25% improvement on the Children's Yale-Brown Obsessive Compulsive Scale modified for Pervasive Developmental Disorders. The primary target of treatment in this study was repetitive, compulsive behavior that commonly occurs in persons with FXS. The study incorporated an ERK activation biomarker assay. Potential adverse effects were assessed in a systematic manner at all clinic visits and by phone between visits. Results. Riluzole treatment was associated with clinical response in 1 of 6 subjects (17%). Among a number of secondary outcome measures employed, significant improvement was only noted on the ADHD Rating Scale-IV (became non-significant when corrected for multiple comparisons). Riluzole use was associated with significant correction in ERK activation time in all subjects (mean change from 3.82 ± 0.27 (baseline) to 2.99 ± 0.26 (endpoint) minutes; p = 0.007). Riluzole was well tolerated; mean increases in liver function tests occurred but drug discontinuation was not required. Conclusion. Overall, riluzole use was not associated with significant clinical improvement despite uniform correction of peripheral ERK activation. Future directions of study include testing of riluzole in animal models of FXS and assessment of psychotropic monotherapy on ERK activation.

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