**5.3.76 Thalidomide**

Thalidomide is a small molecule which has been used as a sedative drug in the 1950s-1960s. Due to its teratogenic and neuropathic adverse effects, its use was discontinued until the 1990s, when thalidomide was introduced in oncology for its anti-angiogenic effects.

With regard to clinical trials in ALS, thalidomide was tested in a phase II clinical trial (NCT00140452) (Stommel et al., 2009), with no improvement in the ALS Functional Rating Scale (ALSFRS) and pulmonary function testing (PFT) curves after nine months of thalidomide treatment. Moreover, thalidomide showed severe side effects, and did not affect anti-inflammatory cytokine levels.

A second phase II clinical trial (NCT00231140) was terminated after severe adverse effects (Thomas Meyer, 2005).

### **5.3.77 L-Threonine**

The hydroxylated essential amino acid L-threonine did not show a benefit in ALS patients (Blin et al., 1992; Tandan et al., 1996).
