Author: Rachael Hansford

Treating seizures associated with Lennox-Gastaut Syndrome

JAMA Neurology publishes Phase 3 study results on the efficacy and safety of FINTEPLA®▼(fenfluramine) oral solution for the treatment of seizures associated with Lennox-Gastaut Syndrome (LGS)

  • Primary endpoint was met demonstrating that fenfluramine, as adjunctive treatment, is effective in significantly reducing the frequency of drop seizures in LGS patients compared to placebo1
  • LGS is a severe childhood-onset developmental and epileptic encephalopathy characterized by drug-resistant seizures with high morbidity2 
  • Fenfluramine was recently approved by the U.S. Food and Drug Administration (FDA), as a treatment option for the treatment of seizures associated with LGS, a rare and devastating lifelong childhood-onset epilepsy5

UCB, a global biopharmaceutical company, announced on May 2, 2022 the publication in JAMA Neurology of its multi-centre, double-blind, placebo-controlled, parallel-group, randomised Phase 3 trial demonstrating that fenfluramine 0.7 mg/kg/day, when added to a patient’s current anti-epileptic treatment regimen for seizures associated with LGS, is effective in reducing the frequency of drop seizures.1 Drop seizures cause a person to suddenly lose muscle tone, become limp, and fall to the ground, with a high likelihood of injury.6 Within the study, drop seizures were further defined as generalised tonic-clonic (GTC), secondary GTC [focal to bilateral tonic clonic], tonic, atonic, or tonic and atonic.1

LGS is a severe childhood-onset developmental and epileptic encephalopathy characterised by drug-resistant seizures with high morbidity2 as well as serious impairment of neurodevelopmental, cognitive and motor functions.3 LGS has far-reaching effects beyond seizures, including issues with communication, psychiatric symptoms, sleep, behavioral challenges and mobility.7 

The trial met its primary efficacy endpoint. Patients taking fenfluramine 0.7 mg/kg/day experienced an estimated mean difference in the reduction of drop seizure frequency by 19.9% from placebo (P=.001). The median percent reduction in the frequency of drop seizures in the 0.7 mg/kg/day group was 26.5%, compared with 14.2% in the 0.2mg/kg/day group, and 7.6% in patients taking placebo (P=.09). In key secondary outcomes, the trial demonstrated that a greater proportion of patients taking fenfluramine experienced a 50% or greater reduction in drop seizure frequency, compared to patients in the placebo group.1 

“Our trial data and the clinical evidence demonstrate the safety and efficacy of fenfluramine for the treatment of seizures associated with LGS and especially for patients where generalised tonic-clonic seizures are the predominant seizure type, where there is a greater risk of mortality,” said Kelly Knupp, M.D., MSCS, FAES, Associate Professor, Children’s Hospital Colorado, Principal Investigator of the study. “LGS is a highly treatment-resistant developmental and epileptic encephalopathy and we need differentiated treatment options, such as fenfluramine, which has a unique mechanism of action different from and complementary to current seizure medications.”

The study also included seizure-type subgroup analyses that demonstrated that fenfluramine 0.7mg/kg/day was highly effective in reducing the frequency of GTCs in nearly 50% of patients. During the maintenance and titration period, patients experienced a decrease in frequency of 45.7% in the fenfluramine 0.7mg/kg/day group, a decrease in frequency of 58.2% in the 0.2 mg/kg/day fenfluramine group, compared with an increase in frequency of 3.7% in the placebo group (P=.001 and P<.001 respectively). The percentage reduction in tonic or atonic seizure frequency was 46.7% in the fenfluramine 0.7mg/kg/day group, compared with 6.8% in the placebo group (P=.046).1

The reason these data are compelling is because GTCs are commonly observed in patients with LGS.9 Moreover, GTCs may result in bodily injury.10,11 Sudden unexpected death in epilepsy (SUDEP) is a major concern for people living with LGS and patients with a history of GTCs have an estimated 10-fold greater risk of SUDEP.4

Fenfluramine was generally well-tolerated in this study. The most common treatment-emergent adverse events included decreased appetite (22%), somnolence (13%), and fatigue (13%).1 The fenfluramine safety database includes long-term cardiovascular safety data for patients treated for up to three years in DS and LGS.5

“This study further validates the importance of fenfluramine as a new treatment option for seizures associated with LGS, including generalised tonic-clonic seizures,” said Mike Davis, Global Head of Epilepsy, UCB. “Through our close connection with the LGS community, we know the challenges they face go beyond treatment resistant seizures to include difficulty with behavior and cognition, and we hope that fenfluramine can provide relief for people living with LGS.” 

Site investigators and caregivers also rated patients as significantly much or very much improved on the Clinical Global Impression of Improvement (CGI-I) scale (investigators 26% vs. 20% vs. 6% and caregivers 34% vs. 27% vs. 5% for 0.7 mg/kg vs. 0.2 mg/kg vs. placebo, respectively).1 

Fenfluramine was approved by the U.S. Food and Drug Administration (FDA) for the treatment of LGS in patients aged 2 and older in March 2022.5 Fenfluramine was also approved for the treatment of Dravet Syndrome in patients aged 2 and older in June 20205 and by the EU Commission in December 2020 as an add-on treatment for seizures associated with Dravet syndrome in patients aged 2 and older.12 UCB acquired Zogenix, Inc. and FINTEPLA® on March 7, 2022.


  1. Knupp K, Scheffer, I, et al. Efficacy and Safety of Fenfluramine for the Treatment of Seizures Associated with Lennox-Gastaut Syndrome: A Randomized Clinical Study. JAMA Neurology. 2022; E1-E11.
  2. Strzelczyk A, Schubert-Bast S. Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies. CNS Drugs. 2021;35(1):61-83. 
  3. Arzimanoglou A, French J, Blume WT, et al. Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology. Lancet Neurol. 2009;8(1):82-93.
  4. Sveinsson O, Andersson T, Mattsson P, Carlsson S, Tomson T. Clinical risk factors in SUDEP: A  nationwide population-based case-control study. Neurology. 2020;94(4):e419-e429.
  5. FINTEPLA® (fenfluramine) oral solution CIV. U.S. Prescribing Information. March 2022. Available at : Last accessed: April 2022 
  6. Mastrangelo M. Lennox-Gastaut Syndrome: A State of the Art Review. Neuropediatrics. 2017;48(3):143-151.
  7. LGS Foundation. LGS Characteristics and Major Concerns Survey. Accessed April 2022.
  8. UCB Data on file. Zogenix, Inc. bioStrategies Group. 2021.
  9. Cross JH, Auvin S, Falip M, Striano P, Arzimanoglou A. Expert opinion on the management of  Lennox-Gastaut syndrome: treatment algorithms and practical considerations. Front Neurol.  2017;8:505.
  10. Gastaut H, Roger J, Soulayrol R, et al. Childhood epileptic encephalopathy with diffuse slow  spike-waves (otherwise known as “petit mal variant”) or Lennox syndrome. Epilepsia. 1966;7(2):139-179.
  11. Cross JH, Galer BS, Gil-Nagel A, et al. Impact of fenfluramine on the expected SUDEP mortality  rates in patients with Dravet syndrome. Seizure. 2021;93:154-159.
  12. FINTEPLA Summary of Product Characteristics. September 2021. Available at: Last accessed: April 2022 
  13. Zogenix Press Release. Zogenix Submits New Drug Application for FINTEPLA® (Fenfluramine) in Japan for the Treatment of Epileptic Seizures Associated with Dravet Syndrome. 21 December 2021. Available at:,fenfluramine)%20for%20the%20treatment%20of. Last accessed: April 2022 
  14. Zogenix Press Release. Zogenix Submits Type II Variation Application to the European Medicines Agency (EMA) to Expand the Use of FINTEPLA® (fenfluramine) for the Treatment of Seizures Associated with Lennox-Gastaut Syndrome. 20 December 2021. Available at: Last accessed: April 2022. 

Please see full Prescribing Information, including Boxed Warning, for additional important information on FINTEPLA.

Refer to the European Summary of Product Characteristics for other adverse reactions and full prescribing information. Date of revision: 04 Nov 2021.

▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. 

NMOSD trial success

ULTOMIRIS® (ravulizumab-cwvz) Met Primary Endpoint in CHAMPION-NMOSD (Neuromyelitis Optica Spectrum Disorder) Phase III Trial

Positive high-level results from the open-label Phase III CHAMPION-NMOSD trial showed that ULTOMIRIS®(ravulizumab-cwvz) achieved a statistically significant and clinically meaningful reduction in the risk of relapse in adults with anti-aquaporin-4 (AQP4) antibody-positive (Ab+) neuromyelitis optica spectrum disorder (NMOSD) compared to the external placebo arm from the pivotal SOLIRIS®PREVENTclinical trial.

ULTOMIRIS, the first and only long-acting C5 complement inhibitor, met the primary endpoint of time to first on-trial relapse, as confirmed by an independent adjudication committee. Notably, no relapse was observed in 58 patients over a median treatment duration of 73 weeks.

NMOSD is a rare and devastating autoimmune disease that affects the central nervous system (CNS), including the spine and optic nerves.1-3 Most people living with NMOSD often experience unpredictable relapses, a new onset of neurologic symptoms or worsening of existing neurologic symptoms, also referred to as attacks, which tend to be severe and recurrent and may result in permanent disability.4-6

Every NMOSD relapse can have debilitating and irreversible consequences, so reducing relapses is critical. Patients on ULTOMIRIS remained relapse free over a median treatment duration of 73 weeks in the trial.

Sean J. Pittock, MD, Director of Mayo Clinic’s Center for Multiple Sclerosis and Autoimmune Neurology and of Mayo’s Neuroimmunology Laboratory and lead primary investigator in the CHAMPION-NMOSD trial

Marc Dunoyer, Chief Executive Officer, Alexion, said: “SOLIRISestablished the role of complement inhibition in preventing relapses in NMOSD, and with ULTOMIRISwe continue to innovate for patients with a more convenient every eight-week dosing schedule. These trial results show that ULTOMIRIS may help patients move towards eliminating relapses, which is an important advancement in the treatment of NMOSD.”

The safety and tolerability of ULTOMIRIS in the Champion-NMOSD trialwere consistent with previous clinical studies and other approved indications. Fifty-six patients are continuing to receive treatment in a long-term extension period, which is ongoing.

The data will be presented and submitted to global health authorities as rapidly as possible to bring forward ULTOMIRIS to the NMOSD community.


  1. Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6(9):805-815.
  2. Wingerchuk DM. Diagnosis and treatment of neuromyelitis optica. Neurologist. 2007;13(1):2-11.
  3. Hamid SHM, Whittam D, Mutch K et al. What proportion of AQP4-IgG-negative NMO spectrum disorder patients are MOG-IgG positive? A cross sectional study of 132 patients. J Neurol. 2017;264(10):2088-2094.
  4. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica. Curr Treat Options Neurol. 2008;10(1):55-66.
  5. Kitley J, Leite MI, Nakashima I, et al. Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan. Brain. 2012;135(6):1834-1849.
  6. Jarius S, Ruprecht K, Wildemann B, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: a multicentre study of 175 patients. J Neuroinflamm. 2012;9:14.
  7. Wingerchuk DM, Hogancamp WF, O’Brien PC, Weinshenker BG. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology. 1999;53(5):1107-1114.
  8. Papadopoulos MC, Bennett JL, Verkman AS. Treatment of neuromyelitis optica: state-of-the-art and emerging therapies. Nat Rev Neurol. 2014;10(9):493.
  9. Cossburn, M., et al. (2012). The Prevalence of Neuromyelitis Optica in South East Wales.” Eur J Neurol., 19(4): 655-659.
  10. Takata K, Matsuzaki T, Tajika Y. Aquaporins: water channel proteins of the cell membrane. Prog Histochem Cytochem. 2004;39(1):1-83.
  11. Mori M, Kuwabara S, Paul F. Worldwide prevalence of neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry. 2018 Jun;89(6):555-556. doi: 10.1136/jnnp-2017-317566. Epub 2018 Feb 7. PMID: 29436488.
  12. Quek AML, Mckeon A, Lennon VA et al. Effects of age and sex on aquaporin-4 autoimmunity. Arch Neurol 2012 and 69:1039–43.
  13. Tüzün E, Kürtüncü M, Türkoğlu R, et al. Enhanced complement consumption in neuromyelitis optica and Behcet’s disease patients. J Neuroimmunol. 2011;233(1-2):211-215.
  14. Kuroda H, Fujihara K, Takano R, et al. Increase of complement fragment C5a in cerebrospinal fluid during exacerbation of neuromyelitis optica. J Neuroimmunol. 2013;254(1-2):178-182.
  15. Jarius, S., Wildemann, B. (2013). The History of Neuromyelitis Optica. J Neuroinflammation 10, 797.
  16. Mealy, M. A., et al. (2019). Assessment of Patients with Neuromyelitis Optica Spectrum Disorder Using the EQ-5D. International journal of MS care, 21(3), 129–134.
  17. An Efficacy and Safety Study of Ravulizumab in Adult Participants With NMOSD. NCT Identifier: NCT04201262. Available online. Accessed April 2022.

New Three-Year Data for Genentech’s Evrysdi (risdiplam)

Long-term improvements in survival and motor milestones in babies with Type 1 Spinal Muscular Atrophy (SMA)

– 91% of infants treated with Evrysdi in the FIREFISH study were still alive at three years –

– Infants treated with Evrysdi maintained or continued to improve in measures of motor function, including their ability to sit without support for 5 and 30 seconds –

– Evrysdi has proven efficacy in infants and adults, with more than 5,000 patients treated to date –

Genentech, a member of the Roche Group, announced 29 April 2022 new three-year data from the FIREFISH study, including one-year data from the open label extension, reinforcing the long-term efficacy and safety of Evrysdi® (risdiplam) in infants with symptomatic Type 1 spinal muscular atrophy (SMA). The data showed an estimated 91% of infants (n=58) treated with Evrysdi were alive after three years of treatment. The Evrysdi-treated infants continued to improve or maintain motor functions, including the ability to swallow, sit without support, stand with support and walk while holding on, between two and three years of treatment. Without treatment, children with Type 1 SMA are never able to sit without support. The study also showed overall continued reductions in serious adverse events (SAEs) and hospitalisations over time.

“These long-term results in babies treated with Evrysdi are very encouraging, with the vast majority improving or maintaining motor functions after three years. Without treatment, they would typically not survive beyond two years of age

The FIREFISH study evaluated the efficacy and safety of Evrysdi in infants aged 1-7 months at the time of enrollment with Type 1 SMA. The study was in two parts, with Part 1 being the dose-finding period and Part 2 evaluating the efficacy and safety at the dose selected in Part 1. The pooled population includes participants treated with Evrysdi at the approved dose for a minimum of three years. These long-term data was presented at the 14th European Paediatric Neurology Society (EPNS) Congress, April 28 – May 2, 2022.

“These long-term results in babies treated with Evrysdi are very encouraging, with the vast majority improving or maintaining motor functions after three years. Without treatment, they would typically not survive beyond two years of age,” said Levi Garraway, M.D., Ph.D., Genentech’s chief medical officer and head of Global Product Development. “Support for the compelling efficacy of Evrysdi continues to grow for a broad range of people, including infants with one of the most severe forms of SMA.”

Infants treated with Evrysdi maintained or continued to improve in their ability to sit without support between 24-36 months. Among the infants with an available assessment (n=48) treated with Evrysdi, 32 infants maintained and 4 gained the ability to sit without support for at least 5 seconds since month 24, as assessed by the Gross Motor Scale of the Bayley Scales of Infant and Toddler Development Third Edition (BSID-III). In addition, 20 infants maintained and 15 gained the ability to sit without support for at least 30 seconds. No infant who gained the ability to sit without support lost this ability after three years of treatment. The majority of infants treated with Evrysdi maintained the ability to feed orally and swallow up to month 36.

Most of the infants treated with Evrysdi continued to improve or maintain measures of the Hammersmith Infant Neurological Examination 2 (HINE-2) between 24-36 months, including being able to hold their heads upright (36 maintained, 3 gained and none lost the ability since month 24), pivot while sitting (15 maintained, 11 gained and none lost the ability), stand with support (6 maintained, 5 gained and 1 lost the ability) and walk while holding on (1 maintained, 2 gained and none lost the ability).

The most common adverse events (AEs) were pyrexia (60%), upper respiratory tract infection (57%), pneumonia (43%), constipation (26%), nasopharyngitis (24%), diarrhea (21%), rhinitis (19%), vomiting (19%) and cough (17%). The most common SAEs were pneumonia (36%), respiratory distress (10%), viral pneumonia (9%), acute respiratory failure (5%) and respiratory failure (5%). The rate of AEs, including pneumonia, continued to decrease over time. The rate of SAEs similarly decreased, with a reduction of approximately 50% after each 12-month treatment period and a 78% reduction between the first and third year of treatment. All AEs and SAEs reported were reflective of the underlying disease and there were no treatment-related AEs leading to withdrawal or treatment discontinuation. The rate of hospitalisations decreased from 1.24 hospitalisations per patient year over 12 months to 0.70 hospitalisations over 36 months. No additional deaths have occurred since the primary analysis of FIREFISH, up to the data cut-off of this analysis (November 23, 2021).

Genentech leads the clinical development of Evrysdi as part of a collaboration with the SMA Foundation and PTC Therapeutics.

Full Prescribing Information

About Genentech

Founded more than 40 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercialises medicines to treat patients with serious and life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California. For additional information about the company, please visit

Keto diet improved life quality of RRMS patients in trial

Eating a ketogenic diet — one low in carbohydrates and high in fats — led to less fatigue and depression for people with relapsing-remitting multiple sclerosis (RRMS) in a small clinical trial that was designed to assess the tolerability of the dietary intervention.

Measures of disability and quality of life also improved during the study while participants were eating a ketogenic diet. Overall, these results support future research to explore the effectiveness of the ketogenic diet in multiple sclerosis (MS), though researchers stressed there is not yet enough evidence to recommend this diet for MS patients outside of closely monitored clinical trials.

Results of the trial were presented at the 2022 annual meeting of the American Academy of Neurology. Full data are now reported in the Journal of Neurology, Neurosurgery and Psychiatry, in the “Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits.”

The Phase 2 trial (NCT03718247), which was sponsored by the University of Virginia, included 64 people with RRMS. Two of the participants were teenagers (ages 15 and 17); the rest were adults. The majority of participants were female and white. During the trial, participants were instructed to eat a ketogenic diet for six months.

Read more at MS News Today.

NfL test for multiple sclerosis

Quanterix Granted Breakthrough Device Designation from U.S. FDA

Blood-based assay has the potential to serve the multiple sclerosis (MS) community in management of relapsing-remitting form of the disease

April 22, 2022 08:30 AM Eastern Daylight Time: Quanterix Corporation, a company digitising biomarker analysis with the goal of advancing the science of precision health, announced that its Simoa® neurofilament light chain (NfL) plasma test has been granted Breakthrough Device designation by the U.S. Food and Drug Administration (FDA) as a prognostic aid in assessing the risk of disease activity in patients diagnosed with relapsing-remitting MS (RRMS).

The FDA’s Breakthrough Device designation is granted to products that have the potential to offer more effective diagnosis or treatment of life-threatening diseases with an unmet medical need. The programme is designed to enable accelerated development, assessment and review processes, with the intention to provide patients with more timely access to breakthrough technologies or devices. However, Breakthrough Device designation does not guarantee that the FDA review and approval process will be shortened or that an application will be approved.

The Quanterix Simoa® NfL test is a digital immunoassay that quantitatively measures NfL in human serum and plasma and shows promise to be used in conjunction with clinical, imaging and laboratory findings as an aid in identifying RRMS patients who are at lower or higher risk for relapse within four years. This prognostic information could be useful in tailoring the therapeutic approach to more effectively treat the disease.

The designation comes on the heels of a large-scale, international study published in The Lancet Neurology, in which researchers from the University Hospital Basel and University of Basel leveraged Quanterix’ ultra-sensitive Simoa® technology to help establish a new method for clinicians to identify and interpret elevated values of sNfL in individual MS patients. Along with this research, the Simoa® NfL assay was referenced in at least 20 studies presented at the American Academy of Neurology (AAN) 74th Annual Meeting, further validating the biomarker’s potential utility.

“There has been an ever-growing body of research with the Simoa® NfL blood test supporting NfL as a reliable biomarker for MS disease activity prognosis and treatment response monitoring,” said Dr. Mark S. Freedman, Professor of Neurology and Director of Multiple Sclerosis Research at the Ottawa Hospital.

The FDA’s grant of Breakthrough Device designation for this test has the potential to help the multiple sclerosis community further advance the optimal use of NfL measurements in both research and clinical practice aimed at more effective therapeutic management of the disease for the millions of patients suffering from the condition.

Dr. Mark S. Freedman, Professor of Neurology and Director of Multiple Sclerosis Research at the Ottawa Hospital

This is the second test from Quanterix to receive Breakthrough Device status – the company’s phospho-Tau 181 (pTau-181) assay for Alzheimer’s disease received the designation in 2021.

To learn more about Quanterix’ Simoa® technology, visit:

Using telemedicine in neuro-oncology – practical guidance

The COVID-19 pandemic has ensured the expansion of telemedicine into nearly every medical specialty. This article summarises current practice and makes recommendations for integrating virtual care in the practice of neuro-oncology. It identifies current telemedicine practice, provides practical guidance for conducting telemedicine visits, and generates recommendations for integrating virtual care into neuro-oncology practice. Practical aspects of telemedicine are summarised including when to use and not use telemedicine, how to conduct a virtual visit, who to include in the virtual encounter, unique aspects of telehealth in neuro-oncology, and emerging innovations. Read the article in Neuro-Oncology Practice.

Study links gut microbiota strains with more severe strokes and poorer post-stroke recovery

A new study has identified strains of gut microbiota that are associated with more severe strokes and worse post-stroke recovery, revealing that the gut microbiome could be an important factor in stroke risk and outcomes1.

The study, presented 28 April 2022 at the European Stroke Organisation Conference (ESOC 2022) pinpointed specific groups of bacteria associated with poorer neurological recovery from ischaemic stroke both in the acute phase (24 hours) and after three months.

The research identified multiple types of bacteria were associated with ischemic stroke risk, including Fusobacterium and Lactobacillus. Negativibacillus and Lentisphaeria were associated with a more severe stroke in the acute phase (at 6 and 24 hours respectively) and Acidaminococcus related to poor functional outcomes at three months. 

Dr Miquel Lledós, lead author from the Sant Pau Research Institute Stroke Pharmacogenomics and Genetics Laboratory, Barcelona, Spain, commented “The influence of the gut microbiome – the trillions of bacteria and other microorganisms that live in the gut – is a modifiable risk factor associated with the risk of stroke and with post-stroke neurological outcomes. However, most research has previously been done in animal models.”

“In this study we took faecal samples – the first samples taken after the event – from 89 humans who’d suffered an ischaemic stroke. Comparing with a control group, we were able to identify multiple groups of bacteria that were associated with a higher risk of ischaemic stroke.”

An ischaemic stroke occurs when a clot or other blockage blocks the blood supply to the brain and is the most common type of stroke. In Europe, 1.3 million people suffer a stroke every year and it is the second most common single cause of death2.

“The discovery opens the exciting prospect that, in the future, we may be able to prevent strokes or improve neurological recovery by examining the gut microbiota. In other pathologies, clinical trials are being carried out where researchers replace the intestinal flora through dietary changes or faecal transplantation from healthy individuals and this should be studied further in the stroke field.”

The association between certain strains of gut bacteria and risk of ischaemic stroke was reinforced in another study presented at ESOC this week by a team from Yale University, Connecticut, USA3.

The researchers analysed statistics from the Flemish Gut Flora Project and the MEGASTROKE consortium, using a technique called Mendelian Randomisation (MR) which measures variation in genes to examine the causal effect of an outcome or exposure. The study identified 20 microbial traits significantly associated with the risk of developing at least one subtype of ischaemic stroke.


  1. Influence of the gut microbiome in ischemic stroke risk and ischemic stroke outcome, presented at the European Stroke Organisation Conference, 4 May 2022.
  2. Status and Perspectives of Acute Stroke Care in Europe | Stroke (
  3. The gut microbiome influences the risk of acute ischemic stroke: a mendelian randomization study, presented at the European Stroke Organisation Conference, 5 May 2022.

Pregabalin may slightly increase risk of major congenital malformations

20 April 2022: The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a drug safety update on the use of pregabalin in pregnancy, after a new study suggests that it may slightly increase the risk of major congenital malformations.

Advice for healthcare professionals is that potentially fertile women should continue to use effective contraception during treatment with pregabalin, and that use of the drug in pregnancy should be avoided unless it is “clearly necessary”.

The latest alert was prompted by the pregabalin pregnancy outcomes study, an observational cohort study in Denmark, Finland, Norway, and Sweden that included over 2700 pregnancies with pregabalin exposure during the first trimester, the largest population-based study to date. 

Read more.

EC marketing authorisation for Vydura for migraine

Pfizer Inc and Biohaven Pharmaceutical Holding Company Ltd announced on 27th April that the European Commission (EC) has granted marketing authorisation for VYDURA® (rimegepant), a calcitonin gene-related peptide (CGRP) receptor antagonist for both the acute treatment of migraine with or without aura, and prophylaxis of episodic migraine in adults who have at least four migraine attacks per month.

VYDURA®, an orally disintegrating tablet, is the first medicine approved for both acute and prophylactic treatment of migraine in the European Union (EU). Migraine is a leading cause of disability worldwide with approximately one in ten people living with the condition in Europe alone. Globally, migraine disproportionately affects women by three to four times compared to men.

There is a significant unmet need for people in the European Union living with the pain and disability caused by frequent migraines. The comprehensive clinical programme has established VYDURA’s efficacy and safety as both an acute and preventive treatment of migraine. Studies in acute migraine demonstrated a rapid and long-lasting relief of migraine headache and other symptoms with a single dose, while the prevention study found a significant reduction in migraine attacks with every other day dosing. We have great confidence in the positive impact VYDURA could have on people living with this debilitating condition in the EU.

Nick Lagunowich, Global President, Pfizer Internal Medicine.

Results from the Phase 3 study published in Lancet demonstrated that a single dose of rimegepant provided superior pain reduction and associated symptoms of migraine at two hours compared to placebo. The prevention study, also published in Lancet, demonstrated that rimegepant taken every other day provided superior reduction in the number of days per month with migraine in Weeks 9 –12 of the 12-week treatment period compared to placebo, that was maintained with continued dosing during the 12-month open-label extension period.

Today’s approval marks a huge step forward for patients in Europe who are living with migraine. Migraine is often overlooked and undertreated, resulting in substantial disability with suboptimal care for patients. VYDURA’s promising efficacy and favorable benefit-risk profile spark hope for people in need of new migraine treatment options. This approval has the potential to advance the standard of care for migraine in the EU and I am hopeful it will improve the quality of life for many people living with the burden of this prevalent neurological disease.

Professor Peter Goadsby, Director of the National Institute for Health and Care Research (NIHR) Clinical Research Facility and Professor of Neurology at King’s College London.

The Marketing Authorisation follows the recommendation for approval by the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) in February. The EC approval will be valid for all 27 EU member states as well as Iceland, Liechtenstein, and Norway and local reimbursement approval will follow. Assessment of the marketing authorisation application by the Medicines & Healthcare products Regulatory Agency (MHRA) is underway and approval is expected to shortly follow in the UK.

About VYDURA® (rimegepant)
VYDURA® targets a key component of migraine by reversibly blocking CGRP receptors. CGRP is increased during a migraine attack, dilates blood vessels and is involved in nociceptor signaling. CGRP receptor antagonists work by reversibly blocking CGRP receptors, thereby inhibiting the biologic activity of the endogenous CGRP neuropeptide.

The Marketing Authorisation for VYDURA® was based, in part, on the review of the results from three Phase 3 studies for acute treatment, a long-term, open-label safety study in acute treatment of migraine and a Phase 3 study with a 1-year open-label extension in the preventive treatment of migraine. VYDURA® is taken orally as needed, up to once daily, to stop migraine attacks or taken every other day to help prevent migraine attacks.

The most frequent adverse event in clinical trials with VYDURA® was nausea, occurring in 3% of patients compared to 1% with placebo, while hypersensitivity reactions including rash occurred in less than 1% of patients. Less than 2% of patients discontinued from VYDURA® due to adverse events. VYDURA® does not have addiction potential and was not associated with medication overuse headache or rebound headache in clinical trials, although overuse of any type of medicinal products for headache can make them worse.

VYDURA® is commercialised as Nurtec® and Nurtec® ODT outside Europe. It is commercialised in the U.S. for the acute treatment of migraine and for the preventive treatment of episodic migraine in adults, and ex-U.S. is approved for the acute treatment of migraine in Kuwait and the United Arab Emirates, and for acute treatment of migraine and preventive treatment of episodic migraine in Israel.

Earlier this year, Pfizer and Biohaven entered into an agreement for the commercialisation of VYDURA®. Under the terms of the agreement, Pfizer has commercialisation rights to rimegepant in markets outside the U.S. Biohaven continues to lead research and development globally and retains the U.S. market.