Tuesday, January 22, 2013

Ampligen: A successful drug for the most severe ME patients

The FDA advisory committee met to discuss Ampligen and its use as a treatment for chronic fatigue syndrome, better known as ME/CFS.  Despite hearing testimony from those who had used the drug and experienced its life changing benefits, the FDA committee voted against its approval.  The committee members asked questions that were reasonable in their attempt to understand the disease that this drug was to address.   However, it was obvious from the questions and the responses that there still remains a tremendous gap between what people think they know about chronic fatigue syndrome and the true devastation that this disease often causes its victims.   Given time and research support, we could learn important information about ME/CFS by thoroughly studying the immunological effects of Ampligen treatments.  Results of such valuable research might also put an end to the misplaced emphasis on “fatigue” as the major biomarker for this disease.

The symptom of fatigue is only one of many more serious symptoms that patients with ME/CFS experience.  The word “fatigue” has created a false impression in the minds of most that this disease is simply a result of a lack of wise energy use.    There is also a mistaken belief that if people with ME/CFS weren’t such overachievers, they would be just fine.  Nothing could be further from the truth.  However, because patients experience a profound loss of energy after becoming ill, the company that makes Ampligen chose to use treadmill testing, or VO2 max testing, as an endpoint to show efficacy of the drug. 

This VO2 challenge test measures the body’s maximum ability to use oxygen efficiently when exercising.  It is commonly used to determine a person’s disability with regards to COPD, a chronic lung disease.   COPD is a well known disease that severely impacts a person’s ability to breathe.   No one has ever linked CFS to this lung disease, but studies have shown that patients with ME/CFS suffer from exercise intolerance.   One wonders if the use of this test could have caused confusion on the part of FDA representatives who may not understand why treadmill testing was used as a biomarker for ME/CFS or more importantly as an endpoint for Ampligen.  They may have been surprised to learn that that such a drug works in a disease that has nothing to do with lung capacity or simple deconditioning.  Perhaps, because some patients with COPD improve their VO2 results with exercise, the misconception is that exercise would likewise be a good therapy for those with ME/CFS.   Interestingly, exercise has just the opposite effect on ME/CFS patients.  Those who are ill suffer more severely when they attempt to return to previous levels of activity.

I suspect that there were many factors, other than misunderstanding the true nature of this illness, which led to the decision not to recommend the approval of Ampligen.  One factor might have been that no one has ever fully explained the mechanisms involved in the VO2 deficit found in patients with ME/CFS.  Nor has anyone described the mechanism of repair in those who take the drug.   Perhaps, had there been a detailed explanation for both phenomena, the FDA might have had better support to back a positive recommendation.  Additionally, Ampligen may have had a better chance at approval had there been more expert testimony from the many physicians who have successfully used Ampligen with their most severely ill ME/CFS patients.  

I don’t mean to sound like I agree with the FDA’s decision.  I do not, because I have witnessed first hand how this drug is incredibly successful at bringing sick individuals from the brink of existence back to a productive life again.  I believe that Ampligen can and should be made available to a subset of patients with ME/CFS.  In those with severe nausea, gastro paresis, tachycardia, cognitive impairment, seizures, and other devastating symptoms, it can be a life saver.  To go from a living death to a healthy existence is by no means an easy feat.   The drug works miracles for some and is all that they have to stop their excruciating suffering.   It is no wonder that these patients continue to fight so hard to keep the drug within their grasp. 

Despite the noticeable physical improvements, important questions remain to be answered.  Why hasn’t Ampligen proven to work for a larger subset of patients with ME/CFS?  What other kinds of biological abnormalities beside oxygen/energy deficits are responding to Ampligen?  Is Ampligen impacting an abnormality in the nervous system?  Is Ampligen repairing a dysregulated immune system? Is Ampligen supporting the mitochondria or power houses of the cells?  What are the key biological abnormalities behind the illness, and how are those abnormalities addressed by Ampligen?  Answers to such questions would help us understand the disease better and answer the question of why Ampligen works so well for some, but not others.   

While we must do much more work to assure all patients receive effective medical care, we can learn a tremendous amount from the Ampligen trials. I believe that Ampligen’s success in this patient population is telling us something important about the disease and those who are most susceptible.   We owe it to the patients to find out what that something is.   Despite the fact that we don’t know the exact mechanisms behind this drug’s efficacy, it has proven to be life saving for some, and therefore, it should be made available to those who truly benefit from its healing properties.  

Annette Whittemore