A cholesterol-lowering statin taken by large numbers of people in the UK could also help people suffering from advanced multiple sclerosis, according to scientists.
There are no convincing treatments for MS once it moves into the later, progressive phase. Early on, most people experience what is known as relapsing-remitting disease, where their condition gets worse and then stabilises. But in the later stages, there is no let-up in decline and sufferers progressively lose muscular function and become more disabled.
But a trial among 140 people in the progressive phase of the disease has provided some hope of a possible treatment to slow the rate of decline.
Researchers, writing in the Lancet medical journal, , say they chose to try statins because they have been shown to have anti-inflammatory and neuroprotective effects on the nervous system.
In the trial they administered high dosage (80mg) simvastatin, the most commonly used of the anti-cholesterol drugs. Half the group, randomly chosen, took the statin for two years, while the others were given a placebo.
"In the progressive stage of MS the brain shrinks by about 0.6% a year. Our main measure of success was to reduce the rate of brain atrophy", said Dr Jeremy Chataway of University College London Hospitals and UCL, who led the study
Some research has suggested that statins may help with multiple sclerosis because they possess neurotrophic and immune system benefits.
A new systematic review and meta-analysis of eight trials has been published, and the eligible studies included five in which statins were used along with interferon in remitting-relapsing MS and one each of statins only for clinically isolated syndrome (CIS), optic neuritis, and secondary progressive MS. The meta-analysis was done on the five trials only, however.
The investigators observed the following trends associated with statin use in the five studies:
- An increase in the proportion of patients with relapse
- An increase in disease activity associated with new T2 lesions
- An increase in whole brain atrophy
Regarding the remaining three studies, the authors noted the following:
- A significant reduction in progression of disability and in brain atrophy in the secondary progressive multiple sclerosis study but no impact on relapse rate
- No effect on relapse activity, risk of multiple sclerosis, or MRI (magnetic resonance imaging) activity in the CIS study
- An improvement in visual outcome but no differences in risk of MS, MRI activity, or relapse activity in the optic neuritis group
This was an early stage, phase II trial, which found that simvastatin reduced the rate of brain shrinkage in patients in the later stages of MS.
The results are promising and warrant a larger phase III trial, examining whether the drug could slow the disease in patients at this stage of MS.
It should be noted that although simvastatin had some effect on outcomes in one disability scale and one symptom scale, the trial was primarily aimed at measuring the effect on brain shrinkage, rather than patients’ symptoms.
To conclude, it is unclear what effect simvastatin, if any, would have on long-term quality of life for MS patients.
A final interesting point is how simvastatin is actually reducing brain shrinkage. If we discovered the mechanisms involved, this could lead to new treatment strategies.
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