Effectiveness of 3,4-Diaminopyridine in Lambert-Eaton Myasthenic Syndrome (DAPPER)

This study is currently recruiting participants.
Verified September 2013 by Jacobus Pharmaceutical
Information provided by (Responsible Party):
Jacobus Pharmaceutical
ClinicalTrials.gov Identifier:
First received: December 24, 2011
Last updated: December 2, 2013
Last verified: September 2013

Hypothesis: 3,4-DAP improves Lambert-Eaton Myasthenic Syndrome (LEMS)-related weakness.

Condition Intervention Phase
Lambert-Eaton Myasthenic Syndrome
Eaton-Lambert Myasthenic Syndrome
Drug: 3,4-DAP
Drug: 3,4-DAP Taper to Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Inpatient Double-Blind Placebo-Controlled Withdrawal Study of 3,4-Diaminopyridine Base (3,4-DAP) in Subjects With Known Lambert-Eaton Myasthenic Syndrome

Resource links provided by NLM:

Further study details as provided by Jacobus Pharmaceutical:

Primary Outcome Measures:
  • Triple Timed Up & Go (TUG) Test [ Time Frame: Participants will be followed for up to 7 days ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Self-assessment of LEMS-related weakness [ Time Frame: Participants will be followed for up to 7 days ] [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: January 2012
Estimated Study Completion Date: April 2014
Estimated Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 3,4-DAP
Half of the subjects will be randomized to continue taking their usual regimen of 3,4-DAP
Drug: 3,4-DAP
Subjects will maintain their usual dosage using tablets on their regular personal schedule
Other Names:
  • 3,4-Diaminopyridine
  • 3,4-Pyridinediamine
  • Diamino-3,4-pyridine
Placebo Comparator: 3,4-DAP Taper to Placebo
Half of the subjects will be randomized to gradually taper their dose of 3,4-DAP down to placebo
Drug: 3,4-DAP Taper to Placebo
Subjects will take decreasing amounts of 3,4-DAP using tablets on their regular personal schedule
Other Names:
  • 3,4-Diaminopyridine
  • 3,4-Pyridinediamine
  • Diamino-3,4-pyridine
  • Placebo

Detailed Description:

The objectives of the study are to confirm the safety and to test the efficacy of 3,4-DAP in the treatment of LEMS-related weakness.

This is a phase 2 randomized double-blind placebo-controlled withdrawal study in subjects with known clinically active LEMS who have been on a chronic stable dose of compassionate distribution Jacobus 3,4-DAP provided through FDA-approved individual investigator-held INDs.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age 18 or over
  2. Ambulatory while taking 3,4-DAP, i.e. the patient can perform the timed up and go (TUG), either with or without an assistive device
  3. Established diagnosis of LEMS, with documentation provided
  4. Continuous use of JPC 3,4-DAP for at least 3 months
  5. Minimum of 3 doses per day with no single dose less than 10 mg of 3,4-DAP
  6. The patient needs to wait about 15 to 30 minutes to experience an unequivocal improvement in a LEMS-induced dysfunction after they take their first dose of 3,4-DAP in the morning [a patient who remains in bed past this point by choice may still be eligible]
  7. Stable regimen of all LEMS-related treatments for at least 3 months
  8. Stable daily regimen of other medications (prescription and over-the-counter) for a minimum of 1 month
  9. Willing to chance being tapered off of 3,4-DAP
  10. Fluency in English
  11. If applicable, agrees to use birth control during heterosexual intercourse until at least 2 weeks after completion of study
  12. A signed informed consent by the study subject

Exclusion Criteria:

  1. Last monoclonal antibody treatment (e.g. rituximab) was less than 6 months ago (i.e., recent treatment is an exclusion)
  2. Clinically significant or poorly controlled condition that in the opinion of the study personnel might pose an unacceptable risk to the patient if entered into the study
  3. Respiratory failure requiring intubation while on 3,4-DAP with no precipitating event or medication
  4. Use of any investigational drug other than 3,4-DAP within the last 30 days
  5. Pregnant or lactating
  6. Current use of other aminopyridines (e.g.4-AP) or guanidine
  7. Does not display a sufficiently large response to 3,4-DAP during the baseline observation period in the CRU to detect a decline during withdrawal of 3,4-DAP
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01511978

Contact: Kathy L Aleš, MD 609-921-7447 ext 238 kathy.ales@jacobus-pharmaceutical.com

United States, California
University of California at Davis Recruiting
Sacramento, California, United States, 95817
Contact: Janelle Butters, RN, CRC    916-734-6276    janelle.butters@ucdmc.ucdavis.edu   
Contact: Molly Lindsay    916-734-6312    molly.lindsay@ucdmc.ucdavis.edu   
Principal Investigator: David P Richman, MD         
Sub-Investigator: Mark A Agius, MD         
Sub-Investigator: Michelle L Apperson, MD, PhD         
United States, Indiana
Indiana University Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Sandy Guingrich, LPN, CCRC    317-963-7415    sguingri@iupui.edu   
Principal Investigator: Robert M Pascuzzi, MD         
Sub-Investigator: Cynthia Bodkin, MD         
Sub-Investigator: John Kincaid, MD         
Sub-Investigator: Riley Snook, MD         
Sub-Investigator: Angela Micheels, PT         
United States, North Carolina
Duke University Recruiting
Durham, North Carolina, United States, 27710
Contact: Kate Beck, RN, CRC    919-668-2278    kate.beck@duke.edu   
Principal Investigator: Vern C Juel, MD         
Sub-Investigator: Janice M Massey, MD         
Sub-Investigator: Lisa D Hobson-Webb, MD         
Sub-Investigator: Jeffrey Guptill, MD         
United States, Oregon
Oregon Health & Science University Recruiting
Portland, Oregon, United States, 97239
Contact: Diana Dimitrova, PhD    503-494-7269    dimitrov@ohsu.edu   
Sub-Investigator: Mananya Satayaprasert, MD         
Sub-Investigator: Julie Khoury, MD         
Principal Investigator: Tessa L Marburger, MD         
Sub-Investigator: Diana Dimitrova, PhD         
Sub-Investigator: Ghazaleh Jafari, MD         
Sub-Investigator: Alexandra Dimitrova, MD         
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Kay J. Artibee, RN, MEd    615-936-8102    kay.j.artibee@vanderbilt.edu   
Contact: Amanda C. Peltier, MD, MS    615-936-5766    amanda.peltier@vanderbilt.edu   
Principal Investigator: Amanda C. Peltier, MD, MS         
Sub-Investigator: Peter D. Donofrio, MD         
Sub-Investigator: Christopher D. Lee, MD, MPH         
United States, Texas
Baylor College of Medicine Recruiting
Houston, Texas, United States, 77030
Contact: Claire J MacAdam, PT, NCS, CCRC    713-798-5694    macadam@bcm.edu   
Principal Investigator: Yadollah Harati, MD         
Sub-Investigator: Cecile Phan, MD, FRCPC         
Sub-Investigator: Shima Mousavi, MD         
United States, Utah
University of Utah Recruiting
Salt Lake City, Utah, United States, 84132
Contact: Charles Latner    801-585-1319    charles.latner@hsc.utah.edu   
Principal Investigator: A. Gordon Smith, MD         
Sub-Investigator: J. Robert Singleton, MD         
Sub-Investigator: Athanasia Politis         
Sub-Investigator: Collin Arsenault         
Sub-Investigator: Charles Latner         
Sponsors and Collaborators
Jacobus Pharmaceutical
Study Director: Kathy L Aleš, MD Jacobus Pharmaceutical
  More Information

No publications provided

Responsible Party: Jacobus Pharmaceutical
ClinicalTrials.gov Identifier: NCT01511978     History of Changes
Other Study ID Numbers: JPC 3,4-DAPPER
Study First Received: December 24, 2011
Last Updated: December 2, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Jacobus Pharmaceutical:

Additional relevant MeSH terms:
Lambert-Eaton Myasthenic Syndrome
Paraneoplastic Syndromes, Nervous System
Paraneoplastic Syndromes
Nervous System Neoplasms
Neoplasms by Site
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Neurodegenerative Diseases
Neuromuscular Junction Diseases
Neuromuscular Diseases
Autoimmune Diseases
Immune System Diseases
Potassium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on April 17, 2014