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No Surgical Innovation Without Evaluation

  • Hirst A
  • Philippou Y
  • Blazeby J
  • et al.
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Abstract

A randomized, controlled trial of miglustat indicated that miglustat (Zavesca??) stabilized neurological disease over 12 months in adult and juvenile patients with Niemann-Pick disease type C (NP-C). We report data from a non-controlled, open-label extension to this initial randomized trial. All patients completing the randomized trial were allowed to continue treatment in a 12-month, non-controlled open-label extension. Those completing 12 months of extension therapy could continue further on miglustat in a 'continued extension' phase. From a total of 29 patients in the randomized phase (mean [??SD] age 24.6 ?? 9.1 years; 52% female), 21 completed 12 months of therapy with miglustat (17 of whom received miglustat in the initial randomized phase, and four in the extension phase), and 15 patients (all from the miglustat-randomized group) completed 24 months on miglustat. Mean horizontal saccadic eye movement velocity (HSEM-??) indicated improvement in the 12-month miglustat group, and stabilization in the 24-month group; swallowing was improved or stable in 86% and in up to 93%, respectively. Ambulation was stabilized in both the 12- and 24-month groups. In an exploratory disease stability analysis of prospective data on key parameters of disease progression (HSEM-??, swallowing, ambulation and cognition), 13/19 (68%) patients receiving ???12 months' miglustat therapy had stable disease. Among all patients receiving ???1 dose of miglustat (n = 28), the most frequent adverse events were diarrhoea, weight decrease, flatulence and tremor. Overall, these data suggest that long-term miglustat therapy stabilizes neurological disease and is well tolerated in adult and juvenile patients with NP-C. ?? 2009 Elsevier Inc. All rights reserved.

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Hirst, A., Philippou, Y., Blazeby, J., Campbell, B., Campbell, M., Feinberg, J., … McCulloch, P. (2019). No Surgical Innovation Without Evaluation. Annals of Surgery, 269(2), 211–220. https://doi.org/10.1097/sla.0000000000002794

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