Statins May Benefit Secondary Progressive MS Patients
The cholesterol-lowering drugs known as statins are controversial for a number of reasons, but for people who are suffering with secondary progressive multiple sclerosis (MS), they may prove to be beneficial. A British team of researchers from various institutions found that simvastatin slowed progression of this advanced stage of MS when compared with placebo.
The majority of the estimated 2.3 million people around the world who have relapsing-remitting MS, which is the typical initial diagnosis, eventually develop the more advanced phase of the disease. Thus far, researchers have not found an effective way to slow this devastating stage of MS.
Simvastatin (Zocor) was designed to reduce levels of cholesterol and other lipids. It is the product of the fermentation of a fungus called Aspergillus terreus and in some people who have high lipid levels, it inhibits the activity of a specific coenzyme which in turn helps limit the production of cholesterol.
In people with MS, however, the statin appears to slow shrinkage (atrophy) of the brain, a characteristic symptom of secondary progressive MS and one that is believed to play a major role in the physical and mental decline of this disease stage. During this stage, the disease transforms from one dominated by symptoms associated with inflammation to one characterized by nerve damage.
The two-year clinical trial involved 140 individuals with secondary progressive MS. When compared with placebo, those who took the statin (80 mg daily) scored significantly better on movement and disability assessments and the rate of atrophy was also significantly lower.
It should be noted that the usual dose of simvastatin for people with high cholesterol is 40 mg daily. The 80-mg dose is associated with an increased risk of myopathy, including rhabdomyolysis, a serious condition in which muscle breaks down and releases substances that can damage the kidneys.
Although the results of this single trial were “quite a surprise” and “promising,” according to coauthor Dr. Richard Nichols, of the Department of Medicine at Imperial College London, further research using larger populations of patients with MS is needed before statins should be considered for this stage of the disease.
Current treatments for secondary progressive MS
For now, patients with relapsing-remitting MS who are transitioning to the secondary progressive form can be treated using dimethyl fumarate (Tecfidera), fingolimod (Gilenya), interferon beta drugs (e.g., Avonex, Betaseron, Extavia, Rebif), natalizumab (Tysabri), and teriflunomide (Aubagio). However, once the individuals stop having relapses, these drugs typically are not helpful, and the only drug approved by the FDA for this stage of the disease is mitoxantrone (Novantrone).
At the same time, there are numerous drugs that can be prescribed to help alleviate symptoms, such as bladder dysfunction, pain, spasticity, dizziness and vertigo, tremors, and balance problems. These medications do not have an impact on disease progression, however.
The majority of MS patients can expect to transition from relapsing-remitting disease to the more severe form. Could cholesterol-lowering statins soon be prescribed for secondary progressive MS?
Chataway J et al. Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomized, placebo-controlled, phase 2 trial. The Lancet 2014 Mar 19 online.