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A preliminary study suggests that combining a interferon treatment in MS with an antibiotic may slow the progress of the disease.
Many patients with relapsing-remitting MS who take interferon (a medication that reduces the effect and frequency of relapses) still experience relapses and may continue to develop new areas of damaged brain tissue (lesions) visible on magnetic resonance imaging (MRI).
US researchers conducted a single-centre trial involving 15 patients (average age 44.5) with relapsing-remitting MS who had been taking interferon for at least six months and were experiencing symptoms and developing new brain lesions. For four months, participants took 100 milligrams daily of the antibiotic doxycycline in addition to continuing their interferon therapy. They underwent monthly neurological examinations, MRI to detect brain lesions and blood work to monitor safety.
After four months, the combination treatment resulted in fewer lesions visible on MRI—60 percent of the patients had more than a one-fourth reduction in the number of lesions from the beginning of the study. The patients also had reduced average scores on a scale designed to assess disability levels. Only one patient relapsed; adverse effects were mild and included only known effects of the two drugs individually rather than new effects associated with combining the medications.
These researchers suggest that “antibiotics in the tetracycline family, including doxycycline, may be effective against MS and other inflammatory diseases by inhibiting the action of enzymes that destroy certain nervous system cells, protecting the brain and increasing the effectiveness of the immune system”
“There is growing interest in combination therapy in patients with MS to stabilise the clinical course, reduce the rate of clinical relapses and decelerate the progressive course of the underlying pathologic mechanism,” they write.
“Overall, data from this cohort suggest that the treatment combination of oral doxycycline and interferon beta-1a may be safe and effective in some patients with MS; however, further controlled clinical trials are warranted to demonstrate safety and efficacy in a larger patient population.”
Reference: Minagar , A. et al. (2007) Combination Therapy With Interferon Beta-1a and Doxycycline in Multiple Sclerosis: An Open-Label Trial Archives of Neurology published 10 December 2007, 10.1001/archneurol.2007.41
Read abstract/source full text of article: http://archneur.ama-assn.org/cgi/content/abstract/2007.41v1?ct
This study observes that progressive nerve injury and inflammatory damage have been shown in the chronic phase of MS, but little is known about the underlying mechanisms.
Researchers studied the gene expression profile in non-lesion containing tissue, the so-called normal-appearing white matter.
They found that genes involved in anti-inflammatory mechanisms driven by oligodendrocytes* may protect the central nervous system environment and thus limit lesion formation, but the activation of pro-inflammatory mechanisms in microglia* may favour disease progression.
Altogether, their findings suggest an inflammatory reaction throughout the whole white matter of a brain with MS, in which oligodendrocytes actively participate. This reaction might further influence and to some extent facilitate lesion formation.
* Oligodedrocytes are cells that insulate the nerve axons in the central nervous system by producing myelin. Microglia are a type of cell that acts as the first and main form of active immune defence in our central nervous system
Reference: Zeis, T. et al. (2007) Normal-appearing white matter in multiple sclerosis is in a subtle balance between inflammation and neuroprotection Brain. 2008; 131(1): p. 288-303
Source full text of article: http://brain.oxfordjournals.org/cgi/content/abstract/131/1/288?ct
This French study investigated whether vaccination against hepatitis B (HB) increases the risk of MS in childhood.
They looked at 143 people with MS with 1122 control participants where the rate of HB vaccination in the 3 years before the study was approximately 32% for both groups. They found that vaccination against HB within the 3-year study period was not associated with an increased rate of a first episode of MS. The rate was also not increased for HB vaccination within 6 months of the study or at any time since birth or as a function of the number of injections or the brand of HB vaccine.
They concluded that vaccination against HB does not seem to increase the risk of a first episode of MS in childhood.
Reference: Y Mikaeloff, Y. et al. (2007) Hepatitis B vaccination and the risk of childhood-onset multiple sclerosis. Archives of Pediatric Adolescent Medicine 1 Dec 2007 161(12): p. 1176.
Source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;18056563
This Italian study set out to assess the proportion of people with relapsing-remitting MS stopping their interferon-beta treatment and the reasons for it.
Those stopping treatment were classified according to the reason: perceived lack of efficacy; side effects and other reasons. They evaluated 225 PwMS (158 women; average age = 36.6 +/- 9.2 years, average disease duration = 8 years +/- 6.1 years, Expanded Disability Status Scale score = 1.9 +/- 1.2) who received Betaferon (46), Avonex (88) and Rebif (91) therapy.
Of the 46% who suspended their therapy, 29% did it because of perceived lack of efficacy, 15% because of side effects and the remaining 2% due to other reasons.
25 out of 33 who suspended treatment because of side effects and 62 out of 65 due to perceived lack of efficacy were switched to another disease-modifying drug. At the end of the follow-up, the majority of these people could continue their treatment.
They concluded that when starting therapy in relapsing-remitting MS, a relatively high proportion of discontinuation is to be expected over time. Switching from a treatment to another taking into account the reasons of drop-out and the disease activity is a suitable option.
Portaccio, E. et al. (2007) Long-Term Adherence to Interferon beta Therapy in Relapsing-Remitting Multiple Sclerosis. European Neurology 30 Nov 2007 59(3-4): p. 131.
Source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;18057899
This study notes that fatigue is one of the most frequent and most disabling symptoms in MS. They investigated the possible association of the MS-related fatigue syndrome with the available disease-modifying therapies and the main disease characteristics in a study of 320 people with MS.
They found the prevalence of severe fatigue (Fatigue Severity Scale score >/=5) was 50%.
Taking into account age, disease subtype, duration and disability, they found no significant association between using disease modifying drugs compared to no treatment at all.
All used disease-modifying drugs successfully to reduce disease activity and inflammation, but they did not appear to exhibit a significant effect on MS-related fatigue.
Reference: Putzki, N. (2007) Prevalence and Severity of Multiple-Sclerosis-Associated Fatigue in Treated and Untreated Patients. European Neurology 30 Nov 2007 59(3-4): p. 136.
Source text of full article: http://highwire.stanford.edu/cgi/medline/pmid;18057900