Edaravone (Radicava) for ALS
Also known as: Radicava, MCI-186
The second FDA-approved ALS drug, edaravone targets oxidative stress — a key driver of motor neuron degeneration.
Mechanism of Action
Edaravone is a free radical scavenger that quenches hydroxyl radicals, peroxynitrite, and lipid peroxyl radicals. It protects motor neurons from oxidative stress-induced apoptosis by preserving mitochondrial membrane integrity and reducing ROS-mediated DNA damage.
General mechanism: Free radical scavenger. Quenches hydroxyl radicals and peroxynitrite to reduce oxidative neuronal damage.
Current Evidence
The pivotal Japanese trial showed 33% less functional decline (ALSFRS-R) vs. placebo over 24 weeks in a selected patient population. Oral formulation (Radicava ORS) improved accessibility. Debate continues about efficacy in broader ALS populations.
Clinical Status: FDA-approved (2017). Oral formulation approved (2022). Available in US, Japan, South Korea, Canada.
Safety Profile
Bruising, headache, and gait disturbance are common. IV formulation requires clinical setting. Oral version better tolerated.
Key Research Questions
- Which ALS patient subtypes benefit most from edaravone?
- Does combination with riluzole provide additive neuroprotection?
- Can oxidative stress biomarkers predict edaravone responders?