Hot Topics and MS Research News for March 2014
Statin Drugs Reduce Brain Atrophy in Secondary Progressive MS
Statins, or cholesterol-lowering, have been studied in multiple sclerosis for years with varying results. In a recent phase 2 study, researchers noted a 43% reduced annualized rate of brain atrophy (shrinkage) in secondary-progressive MS (SPMS) patients (n=140) taking 80mg simvastatin vs placebo over a 2-year time period. This study appears to be the first conducted specifically in SPMS, a form of the disease which is characterized more by brain atrophy than RRMS which involves primarily CNS inflammation. Measuring brain atrophy has become increasingly important in the study of MS as it is may be more indicative of disability and disease progression than more common indicators such as brain and spinal cord lesions.
But statin drugs may not be effective for use in all MS patients. Previous clinical trials testing the use of statin drugs as an add-on therapy to interferon betas in RRMS patients failed to demonstrate effectiveness. Also, some studies suggest that statin drugs, such as lovastatin or simvastatin, may interfere with the remyelination process in patients with MS. More research is necessary to determine the benefit of statin drugs in progressive forms of the disease which currently have limited treatment options.
Chataway J, Schuerer N, Alsanousi A, et al. Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2 trial. Lancet. 2014 Mar 18. pii: S0140-6736(13)62242-4. doi: 10.1016/S0140-6736(13)62242-4. [Epub ahead of print]
Lisa Emrich. “High-dose statin therapy reduces brain atrophy in Secondary Progressive MS, a new study finds.” MultipleSclerosis.net, 20 March 2014. Accessed at http://multiplesclerosis.net/news/high-dose-statin-therapy-reduces-brain-atrophy-secondary-progressive-ms-new-study-finds/
Testosterone Treatment as Complementary Therapy in Men with MS
Current treatments in MS aim primarily to prevent inflammation and reduce white matter lesions in the central nervous system, but have modest effect on long-term disability and gray matter (brain) atrophy. Some studies have suggested that sex hormones play a role in protecting against nerve damage. In a phase 2 pilot clinical trial, ten men with relapsing-remitting MS were observed during a 6-month non-treatment period, then treated with testosterone for 12 months. During the non-treatment phase, significant gray matter atrophy (shrinkage) was observed (p≤ 0.05 corrected). However, during testosterone treatment, gray matter loss was no longer evident. In fact, a significant gray matter increase in the right frontal cortex was observed (p≤ 0.05 corrected). These observations support the potential of testosterone treatment to stall (and perhaps even reverse) neurodegeneration associated with MS. Authors note that this is the first report of gray matter increase as the result of treatment in MS and that treatment with testosterone was shown to be safe. Further study of the neuroprotective effects of testosterone are warranted in larger, placebo-controlled trials.
Kurth F, Luders E, Sicotte NL, Gaser C, Giesser BS, Swerdloff RS, Montag MJ, Voskuhl RR, Mackenzie-Graham A. Neuroprotective effects of testosterone treatment in men with multiple sclerosis. Neuroimage Clin. 2014 Mar 6;4:454-60. doi: 10.1016/j.nicl.2014.03.001.
DMT Therapy and Postpartum Relapses
Often women with MS who are pregnant experience fewer relapses, especially during the 3rd trimester, but have an increased risk of postpartum relapses. In women who choose to breastfeed, use of disease-modifying treatment (DMT) is not recommended. A retrospective study in women with MS who gave birth aimed to determine whether treatment with an interferon beta or glatiramer acetate shortly after delivery reduces the otherwise increased risk of postpartum MS relapses.
Of 114 live births (112 women), 80 babies (70%) were breastfed little or not at all, 32 (28%) were breastfed exclusively for at least the first 2 months postpartum, and 2 (2%) had insufficient documentation in their medical records to determine the exposures or outcomes. Of the 80 women who breastfed little or not at all, 55 (69%) resumed treatment with interferon beta (n = 34) or glatiramer acetate (n = 21) within 1 year postpartum, whereas the remainder resumed treatment either much later or not at all. Of the 55 women who resumed DMT therapy, 17 (31%) did so within 15 days postpartum, 29 women (53%) between 16 and 180 days, and 9 (16%) between 181 and 365 days. Thirty-seven (67%) of these 55 treated women relapsed within 2 years, most of whom (n = 26) relapsed within 6 months postpartum. Fourteen women waited until they had their first postpartum relapse before resuming treatment.
Researchers found that resuming DMT therapy within 2 weeks postpartum did not decrease the risk of relapse in the 2 years postpartum compared with women who resumed treatment later in the postpartum year (p = 0.6). There was no difference in relapse rates between the groups in the first 6 months postpartum. However, resuming treatment early may reduce the risk of subsequent relapses later in the postpartum year (p = 0.08).
Beaber BE, Chi MD, Brara SM, Zhang JL, Langer-Gould AM. Immunomodulatory agents and risk of postpartum multiple sclerosis relapses. Perm J. 2014 Winter;18(1):9-13. doi: 10.7812/TPP/13-090.
Other studies of interest:
Bhattacharya RK, Vaishnav N, Dubinsky RM. Is there an increased risk of hip fracture in multiple sclerosis? Analysis of the Nationwide Inpatient Sample. J Multidiscip Healthc. 2014 Feb 13;7:119-22. doi: 10.2147/JMDH.S54786. eCollection 2014.
Florindo M. Inflammatory Cytokines and Physical Activity in Multiple Sclerosis. ISRN Neurol. 2014 Jan 27;2014:151572. eCollection 2014.
Hansen D, Feys P, Wens I, Eijinde BO. Is walking capacity in subjects with multiple sclerosis primarily related to muscle oxidative capacity or maximal muscle strength? A pilot study. Mult Scler Int. 2014;2014:759030. doi: 10.1155/2014/759030. Epub 2014 Jan 29.
Jacobsen CO, Farbu E. MRI evaluation of grey matter atrophy and disease course in multiple sclerosis: an overview of current knowledge. Acta Neurol Scand Suppl. 2014 Apr;(198):32-6. doi: 10.1111/ane.12234. Epub 2014 Mar 4.
Jongen PJ, Ruimschotel R, Heerings M, et al. Improved self-efficacy in persons with relapsing remitting multiple sclerosis after an intensive social cognitive wellness program with participation of support partners: a 6-months observational study. Health Qual Life Outcomes. 2014 Mar 19;12(1):40. doi: 10.1186/1477-7525-12-40.
Tsivgoulis G, Sergentanis TN, Voumvourakis K, et al. Chronic cerebrospinal venous insufficiency and multiple sclerosis: a comprehensive meta-analysis of case-control studies. Ther Adv Neurol Disord. 2014 Mar;7(2):114-136.