Predicting responsiveness to fampridine in gait‐impaired patients with multiple sclerosis

Background and purpose Fampridine leads to significant improvements in walking in many people with multiple sclerosis (PwMS). However, a relevant proportion of PwMS does not respond to fampridine and predictors of initial drug responsiveness are unknown. Methods Drug response to prolonged‐release (PR)‐fampridine was assessed in 55 PwMS using the timed 25‐foot walk (T25FW), 6‐min walk test (6MWT) and 12‐item multiple sclerosis walking scale as outcome parameters. Patients were treated with PR‐fampridine and placebo for 6 weeks each in a randomized, double‐blind, placebo‐controlled trial with crossover design (NCT01576354). Possible predictors of drug responsiveness were investigated by multiple correlation analysis and binary logistic regression models. An additional longitudinal analysis followed the drug responses of 32 patients treated with PR‐fampridine over 3 years to identify potential predictors of long‐term drug responsiveness. Results Severity of walking disability was positively correlated with enhanced responses to PR‐fampridine. The strongest single predictor of drug responsiveness was poor 6MWT performance at baseline, which was positively correlated with enhanced drug response in the 6MWT (R = −0.541; P