Research news - February 2006
Open Door - February 2006 pages 4-5
- Potential new oral drug for relapsing remitting MS
- Azathioprine for relapsing remitting MS
- Who benefits from inpatient rehabilitation?
- Resistance training may be helpful
- How do relationships fare in MS?
- MS symptoms fluctuate with hormone levels
- How effective is bee sting therapy?
- Perceived benefits received from conventional and complementary medicine
Potential new oral drug for relapsing remitting MS
Researchers report promising results from a one year phase II study of FTY720, a new oral tablet for people with relapsing remitting MS.
People received either FTY720 in 1.25mg or 5mg doses, or a placebo (dummy drug). People on active treatment experienced around 50% fewer relapses after six months, and this low relapse rate continued for the rest of the trial. MRI scans showed that more than 80% were free from active lesions at the end of the study, regardless of the dosage of their drug. People who initially received placebo and were switched to active treatment for the second six month period also experienced a significant fall in relapse rate.
FTY720 appears to be well tolerated, with the most commonly reported side effects being minor infections (colds, flu), headache, diarrhoea and nausea. Novartis, the manufacturers, are applying to start a bigger phase III trial.
Kappos L, et al.
Promising results with a novel oral immunomodulator - FTY720 - in relapsing multiple sclerosis.
Multiple Sclerosis 2005;11(supp1):S13.
Azathioprine for relapsing remitting MS
A small, open-label study in 14 people with MS in Italy has shown that azathioprine (Imuran) reduces relapses and also appears to reduce the number of new brain lesions formed. MRI scans for six months before and six months during treatment showed that the formation of new lesions was reduced by at least half in 12 participants. However, researchers noted that azathioprine significantly reduced the white blood cell count, by around 40% on average.
Azathioprine is licensed for use with MS in Europe and is used in some specialist centres in the UK.
Massacesi L, et al.
Efficacy of azathioprine on multiple sclerosis new brain lesions evaluated using magnetic resonance imaging.
Archives of Neurology 2005; 65(12):1843-1847.
Who benefits from inpatient rehabilitation?
The majority of people receiving intensive rehabilitation treatment improve. However, improvement varies.
In this study, 230 people admitted to an MS rehabilitation ward were given an individual, goal-oriented treatment programme. People with shorter disease duration, fewer neurological problems and only mild cognitive impairment responded better to rehabilitation for activities of daily living, such as dressing etc. Improvements in mobility and walking were directly related to ability to walk before starting treatment. Overall, people with moderate MS symptoms responded better to rehabilitation than those more severely affected, suggesting that rehabilitation should be available at an early stage.
Grasso MG, et al.
Prognostic factors in multidisciplinary rehabilitation treatment in multiple sclerosis: an outcome study.
Multiple Sclerosis 2005;11(6):719-724.
Resistance training may be helpful
A very small study of eight people with MS using standard gym equipment has found that resistance training may be an effective way to improve walking for people who have moderate disabilities. After two months of a progressive resistance training programme, the participants, all of whom were walking at the start of the programme, demonstrated improvements in length and fluidity of walking strides, with a reduction in pauses for balance and recovery between strides. Falls in levels of fatigue and self-reported disability were also recorded.
Gutierrez GM et al.
Resistance training improves gait kinematics in persons with multiple sclerosis.
Archives of Physical Medicine and Rehabilitation 2005;86(9):1824-1829.
How do relationships fare in MS?
An American study has found depression to be a key factor in relationship problems for people with MS.
64 people with MS and 49 of their partners were given a number of psychological tests to assess whether fatigue, depression and cognitive problems can be used to predict relationship difficulties.
Depression was the single most significant factor. However, the researchers concluded that relationships that are under strain may cause someone with MS to become depressed; alternatively, relationships in which one person is experiencing depression may be under significant levels of stress. Fatigue was found to be another important factor, and may also be directly related to depression. Authors conclude that treatment of depression - normally straightforward - may help improve relationships.
King KE, et al.
Predictors of dyadic adjustment in multiple sclerosis.
Multiple Sclerosis 2005;11(6):700-707.
MS symptoms fluctuate with hormone levels
A small Swedish study suggests that whilst changes in oestrogen levels affect some women, the majority are not affected by hormonal changes.
92 women with MS reported on their symptoms in relation to menstruation, pregnancy, childbirth, menopause and use of oral contraceptives or hormone replacement therapy (HRT).
Results showed no consensus. At menopause, 40% reported worsening symptoms, and 5% improved symptoms. In pregnancy, 25% experienced improved symptoms, and 10% worsened symptoms. After childbirth, 5% experienced a decrease in symptoms, and 36% an increase in symptoms. Few changes in symptoms were reported in relation to HRT or oral contraception.
Holmqvist P, et al.
Symptoms of multiple sclerosis in women in relation to sex steroid exposure.
Maturitas 2005 Nov 14.
How effective is bee sting therapy?
The first clinical trial of bee sting therapy has been conducted in the Netherlands. Researchers compared 13 people receiving the therapy every week for 24 weeks with 13 people receiving no treatment. Results were measured using MRI scans, relapse rate, disability, fatigue and quality of life scales. At the end of the study, no difference was found between the two groups on any of these measures. However, bee sting therapy was well tolerated and there were no serious adverse events.
Wesselius T et al.
A randomised crossover study of bee sting therapy for multiple sclerosis.
Neurology 2005; 6(11): 1764-1768.
Perceived benefits received from conventional and complementary medicine
A study in Oregon asked 1,913 people with MS to rate their experience ofconventional medicine compared with complementary medicine providers. Overall, conventional therapies and providers were preferred, however, people with moderate MS symptoms had better experience of complementary providers compared with those with severe symptoms. Emotional support was the single biggest difference, with complementary medicine providers scoring more highly than neurologists in terms of listening skills, care and concern, and patient empowerment. Researchers speculate that these may be significant for improved quality of life.
Shinto L, et al.
The perceived benefit and satisfaction from conventional and complementary and alternative medicine (CAM) in people with multiple sclerosis.
Complementary Therapies in Medicine 2005; 13(4):264-272.
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