Can Estrogen Reduce Relapses in Women with Multiple Sclerosis?

Multiple Sclerosis
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A form of estrogen called estriol reduced the relapse rate by 47 percent in women who had multiple sclerosis and who were taking the prescription drug Copaxone (glatiramer). This benefit was seen after one year of treatment with the hormone and drug combination.

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It’s still too early for doctors to prescribe the combination of estriol and Copaxone, as these results were seen in a Phase II clinical trial and more research (a Phase III clinical trial) is needed. However, the results of this trial could mean some women may experience significant relief regarding relapses once all the results are in.

About the estrogen and Copaxone study
A total of 158 women with relapsing-remitting MS participated in the randomized, double-blind, placebo-controlled trial, which was conducted at 16 sites throughout the United States. Sorry, no gentlemen were involved in this study.

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Half of the women were given an 8 milligram estriol pill daily along with Copaxone while the other half received a placebo pill daily and the drug. Women who took the female hormone not only had a significantly lower relapse rate than did their peers, they also

  • Scored higher on cognitive tests and
  • Showed faster and stronger improvement after two years than did women in the placebo group

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Why did researchers choose estriol?
Several important findings were behind the reason why estriol was used in the study.

  • Numerous research studies have shown us that estrogen helps protect the female brain from cognitive problems, such as memory loss, lack of concentration, reduction in verbal skills, and other mental impairments
  • Previous MS mouse model studies conducted by the same author of the new research, neurologist Dr. Rhonda Voskuhl of the University of California Los Angeles, showed that giving estriol to the animals resulted in repair of their brain cells, which in turn improved cell communication and thus allowed for better function
  • Studies have also shown that women with MS who get pregnant experience a sharp decline in relapses. Coincidentally, estriol levels rise dramatically during pregnancy

Thus estriol seemed to be a likely candidate for study, and based on the findings of this trial, it was a good choice. As always, however, there are questions and cautions to be considered.

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For example, it’s been shown that giving estrogen to older postmenopausal women (65 and older) can increase the risk of stroke, heart disease, and dementia. What are the long-term effects of this combination treatment? What about men who have MS?

If the results of a future Phase III clinical trial of estriol and Copaxone are successful, some female patients with MS could choose this combination therapy to manage the disease. In the meantime, women with MS may want to ask their healthcare providers what they think about this potential treatment.

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SOURCES
Rocca WA et al. Increased risk of parkinsonism in women who underwent oophorectomy before menopause. Neurology 2007 Aug 29 online
UCLA Health System release

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