MS research update - 19 February 2010
- Interferon beta and daclizumab combined treatment significantly more effective than interferon beta alone
- Statins combined with interferon beta reduce relapse rates and MRI activity
- Oligoclonal bands and early MRI scans in CIS predict risk and rate of conversion to MS
Interferon beta and daclizumab combined treatment significantly more effective than interferon beta alone
The present study investigated the effects of combining interferon beta treatment with the monoclonal antibody, daclizumab, in people with active relapsing MS. 230 people who had been on interferon beta for at least six months, were randomly allocated to one of three groups: high dose daclizumab, low dose daclizumab, or placebo, in addition their standard interferon beta therapy. Daclizumab was given every two or four weeks over 24 weeks and participants were assessed for a further 48 weeks.
MRI scans before, after, and during treatment were used to monitor the appearance of new or larger active lesions.
The findings showed a 72% reduction in active lesions in the high dose daclizumab group and a 25% reduction in active lesions in the low dose daclizumab group compared to the placebo group. Daclizumab was generally well tolerated.
The authors conclude that this study provides compelling evidence for the benefits of daclizumab as an add-on therapy whilst acknowledging that further larger studies are necessary to confirm its safety and effectiveness.
Wynn D, Kaufman M, Montalban X, et al.
Daclizumab in active relapsing multiple sclerosis (CHOICE study): a phase 2, randomised, double-blind, placebo-controlled, add-on trial with interferon beta.
Lancet Neurology 2010 [Epub ahead of print].
View abstract
Stuve O, Greenberg BM.
Anticipated benefits and surprising effects of daclizumab in multiple sclerosis.
Lancet Neurology 2010 [Epub ahead of print].
View abstract
Statins combined with interferon beta reduce relapse rates and MRI activity
Research suggests that statins (cholesterol lowering medicines) may have anti-inflammatory properties. The present study investigated the potential therapeutic role of statins in the treatment of MS when used as an add-on therapy to interferon beta. 45 people with relapsing MS who continued to experience relapses whilst on interferon beta therapy were randomised to one of two groups: 21 people received interferon beta plus low dose atorvastatin; 24 people received interferon beta alone, for a period of 24 months.
Study participants underwent a series of assessments including blood tests and measurement of disability (using EDSS) every three months, and had MRI scans before commencing the trial and at 12 and 24 months into the study.
At the end of the study, the group who had received the combined treatment had significantly fewer active lesions on MRI scanning and a significant reduction in the frequency of their relapses compared to the two years prior to the study. Further studies are needed to clarify the potential of statins as an add-on therapy to interferon beta in the treatment of multiple sclerosis.
Lanzillo R, Orefice G, Quarantelli M, et al.
Atorvastatin combined to interferon to verify the efficacy in relapsing remitting active multiple sclerosis patients: a longitudinal controlled trial of combination therapy.
Multiple Sclerosis 2010; [Epub ahead of print].
Medline abstract
Oligoclonal bands and early MRI scans in CIS predict risk and rate of conversion to MS
In the case of a clinically islolated syndrome (CIS), the detection of oligoclonal bands (laboratory indicators) in the cerebrospinal fluid - the fluid that fills and protects cavities in the brain and spinal cord - can be an important way of determining the likelihood of conversion to clinically definite MS.
The present study investigated whether the presence of oligoclonal bands adds valuable information in predicting CIS conversion to clinically definite MS and time to conversion.
The study was based on the data of 40 people with MS who presented with a clinically isolated syndrome and underwent MRI scanning and testing for oligoclonal bands within the following two months. Of these, 93% had abnormalities on MRI and 87% tested positive for oligoclonal bands. The risk of conversion to clinically definite MS was significantly higher in people who tested positive for oligoclonal bands and had abnormalities on their first MRI scan compared to people who were negative for both or one of the tests.
The study concluded that people who present with CIS have a higher risk for converting to clinically definite MS when they test positive for oligoclonal bands and if this is combined with abnormalities on their first MRI scan conversion occurs sooner.
Ignacio RJ, Liliana P, Edgardo C, et al.
Oligoclonal bands and MRI in clinically isolated syndromes: predicting conversion time to multiple sclerosis.
Journal of Neurology 2010 [Epub ahead of print].
Medline abstract