LONDON—Treatment of patients diagnosed with progressive forms of multiple sclerosis (MS) with lipoic acid appeared to improve patients outcomes, in particular, reducing the rate of brain atrophy, researchers reported at the Congress of the European Committee for Treatment and Research in Multiple Sclerosis.
In a small placebo-controlled trial, magnetic resonance imaging revealed a lower rate of whole brain atrophy in the 27 patients with secondary-progressive MS when they were compared with 24 similar patients given placebo, said Rebecca I. Spain, MD, a principal investigator at the Oregon Health and Science University in Portland.
The rate of brain volume decline over time in those who took lipoic acid supplements was 0.22 percent per year compared with 0.65 percent per year in those who were assigned to receive placebo, Dr. Spain said in her platform presentation. She said the 66 percent relative reduction achieved statistical significance (p=0.004) for the primary outcome of the study.
Dr. Spain said lipoic acid may have therapeutic potential in several areas, including maintenance of the blood brain barrier, inhibition of inappropriate microglial/macrophage activation, and in support of mitochondrial function and structure.
In the double-blinded pilot trial of lipoic acid, Dr. Spain and colleagues studied 51 people with confirmed secondary-progressive MS for 96 weeks. Patients received either an oral dose of 1,200 mg per day of lipoic acid or placebo. The outcomes were adjusted for age, sex, and duration of MS.
Participants were monitored using yearly magnetic resonance imaging scans to measure whole brain atrophy, atrophy of brain substructures and the spinal cord, atrophy of the retina and macular region in the eye, and by clinical assessment and questionnaires to determine impact on symptoms and quality of life. Eye examinations were also provided at baseline and each year in the trial.
Dr. Spain said that aside from reduction in the rate of brain atrophy there were no other significant differences between the patients on lipoic acid and those on placebo. However, in the Timed 25-Foot Walk Test, patients on lipoic acid completed the task one second faster after treatment, while those on placebo took an average of one second longer to walk that distance (p=0.057).
“The patients in this trial were older, had been diagnosed longer, and were more disabled than other patients in other trials,” Dr. Spain noted.
The main side effects of treatment with lipoic acid are gastrointestinal upset and malodorous urine, Dr. Spain said. When the researchers examined adverse events, they found that 17 percent of patients were troubled by lipoic acid compared to 3 percent of patients on placebo. On the other hand, the researchers noted that falls occurred less often in the patients on the active treatment compared to those receiving placebo: about 15 percent of the patients on lipoic acid reported having fallen compared with 38 percent of the patients in the placebo group.
The responses observed in patients with secondary-progressive MS were promising enough to warrant a larger trial to confirm the results.