MS research update - 2 October 2009
- Antidepressant, rolipram, ineffective in reducing number of lesions on MRI
- Combination of glatiramer acetate (Copaxone) and minocycline effective in relapsing remitting MS
- Reducing the cognitive side effects of drugs for overactive bladder
Antidepressant, rolipram, ineffective in reducing number of lesions on MRI
Rolipram, initially developed as an antidepressant, has also been found to have anti-inflammatory actions and has been shown to be effective in animal models of multiple sclerosis. Based on these observations, the investigators tested the efficacy of rolipram in suppressing brain inflammatory disease activity in multiple sclerosis in an open-label clinical trial. People with MS were evaluated by monthly MRI and clinical examinations during three months of pre-treatment baseline and 8 months of rolipram therapy.
The trial was stopped early because the drug was poorly tolerated and because of safety concerns: the investigators observed an increase, rather than decrease, in the brain inflammatory activity as measured by MRI. The reasons for the discrepancy between the promising results in animal models and clinical studies of multiple sclerosis remains unclear.
Bielekova B, Richert N, Howard T et al.
Treatment with the phosphodiesterase type-4 inhibitor rolipram fails to inhibit blood-brain barrier disruption in multiple sclerosis.
Mult Scler. 2009 Sep 23. [Epub ahead of print].
Medline abstract
Combination of glatiramer acetate (Copaxone) and minocycline effective in relapsing remitting MS
Minocycline is a broad spectrum antibiotic which has also been found to have neuroprotective properties in laboratory studies. All the current disease modifying drugs are considered partially effective, so a treatment approach which combines drugs targeting different aspects of the immune process of MS may be more successful.
This double-blind, placebo controlled study evaluated the combination of minocycline with glatiramer acetate (Copaxone) on the number of active inflammatory lesions measured by MRI. 44 participants who were starting treatment with glatiramer acetate were randomized to take in addition either minocycline or placebo for nine months. In this short-term phase II study, MRI and clinical findings suggest that adding minocycline to glatiramer acetate may be of benefit. Although none of the treatment differences were statistically significant, the trend in results generally favoured combination therapy and the investigators suggested that further studies of this combination are warranted.
Metz LM, Li D, Traboulsee A et al.
Glatiramer Acetate in Combination with Minocycline in Patients with Relapsing-Remitting Multiple Sclerosis: Results of a Canadian, Multicenter, Double-Blind, Placebo-Controlled Trial.
Mult Scler. 2009 Sep 23. [Epub ahead of print].
Medline abstract
Reducing the cognitive side effects of drugs for overactive bladder
People with MS may experience bladder urgency and/or frequency, collectively described as an overactive bladder. A group of drugs known as antimuscarinics (or anticholinergics) may be prescribed to calm the bladder. However, this group of drugs may also make mental skills, also known as cognitive function, less efficient. This investigation reviewed and analysed data from a number of published studies which compared the effects of different antiimuscarinic drugs, including oxybutynin, tolterodine, solifenacin, trospium and darifenacin on cognitive skills. Five randomised, double-blind, multiple-dose studies of cognitive function were identified. Oxybutynin was most often associated with impaired mental skills (in four studies) while darifenacin did not affect cognition (three studies). There was limited or no data available for the remaining drugs (tolterodine, solifenacin and trospium).
Kay GG, Ebinger U
Preserving cognitive function for patients with overactive bladder: evidence for a differential effect with darifenacin.
Int J Clin Pract. 2008 Nov;62(11):1792-800.
Medline abstract