Letters

Riluzole for motor neurone disease

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7297.1305 (Published 26 May 2001) Cite this as: BMJ 2001;322:1305

More trials are needed

  1. Josie Sandercock, research fellow,
  2. Amanda Burls, senior clinical lecturer,
  3. Chris Hyde, senior clinical lecturer,
  4. Anne Fry-Smith, information scientist,
  5. Pelham Barton, lecturer,
  6. Stirling Bryan, senior lecturer,
  7. Antony Stewart, senior lecturer
  1. Health Services Management Centre, University of Birmingham
  2. School of Health Sciences, University of Wolverhampton, Wolverhampton WV1 1SB
  3. University of Birmingham Clinical Trials Unit, Birmingham B15 2RR
  4. Section of Old Age Psychiatry, Institute of Psychiatry, London SE5 8AF

    EDITOR—We wrote the assessment report of riluzole in motor neurone disease, which was commissioned by the health technology assessment programme for the National Institute for Clinical Excellence (NICE). 1 2 We believe that a superficial reading of the advice recently issued by NICE on this subject may not give an adequate understanding of the evidence base for this treatment. 3 4

    The evidence in favour of riluzole for use in the amyotrophic lateral sclerosis form of motor neurone disease is very weak. The pooled effect estimates for survival outcomes are not conventionally significant, but of greater concern is the disagreement between the trials about the direction and the size of the treatment effect; this apparent heterogeneity remains unexplained.

    A European public assessment report from the European Agency for the Evaluation of Medicinal Products also expressed concern about the use of riluzole, in view of the limited evidence of an effect on survival without evidence of a slowing in the rate of deterioration of functional status.5 The opinion concludes that there are therefore remaining uncertainties on the product in the management of amyotrophic lateral sclerosis. No further trial data have become available since this time. In the interests of patients we make the following plea to the …

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