In the last 20 years, the number of treatment options for multiple sclerosis has grown tremendously. Frustratingly, however, therapies indicated for people dealing with progressive forms of the disease are few. Data show that although 85% of patients are diagnosed with relapsing-remitting MS, over time more than half of those will develop progressive MS—meaning the disease is no longer characterized by relapses and is more clinically and persistently present. The lack of treatments for secondary and primary progressive MS is a glaring gap in available therapy options of people living with MS.
Recent study results, however, may provide a glimmer of hope in the search for an effective therapy for progressive stages of MS—and it’s one that is widely used for another condition. The drug is simvastatin, commonly known as Zocor. It is among a class of drugs called statins that are prescribed to control high cholesterol.
The study, which was conducted in the UK, involved 140 patients with secondary progressive MS. All participants were randomized into two groups. For 24 months, one group received 80 mg of simvastatin a day and the other received placebo. The researchers’ end point—meaning how they measured study success—was whole-brain atrophy (brain volume loss). As such, at month one, six, 12 and 24 researchers assessed all participants’ brain volume on MRI, and conducted tests to assess physical and psychological status.
Though the study was preliminary with a relatively small sample size, results were encouraging. The rate of non-MS brain atrophy is about .1% each year, whereas for persons with progressive MS that rate is about .6%. Although brain atrophy occurred in both the simvastatin and placebo groups, brain volume loss in the simvastatin group was 43% less than in the placebo group (.584 to .288). The reduction was seen in three-fourths of the simvastatin group and was apparent on MRIs that occurred at month 12 and 24. There didn’t appear to be a significant change in lesion activity, though there was a slight benefit in the treated group.
It is not clear why the simvastatin decreased brain atrophy in the study. Researchers surmise that it may have to do with the cell protective properties of statins, which could make sense given that MS attacks and damages neurons (nerve cells) as well as myelin. This is especially interesting because all currently approved MS therapies are considered anti-inflammatory, whereas simvastatin appears to be neuro-protective.
Simvastatin may also benefit persons with relapsing-remitting MS. A 2004 study, led by a team that included Rocky Mountain MS Center physicians Drs. Tim Vollmer and John Corboy, explored the effect of simvastatin on 30 participants with relapsing-remitting MS, and measured simvastatin’s effect on gadolinium (Gd)-enhancing lesions. When lesions enhance on MRI, the enhancement indicates an area of inflammation and breakdown of the blood-brain barrier.
Participants were monitored for three months with monthly MRIs, and those with at least one Gd-enhancing lesion began taking 80 mg of simvastatin at month four. During the remaining three months of the study, the average number of Gd-enhancing lesions was compared to pretreatment MRI scans. This comparison—between pre-treatment and post-treatment scans—demonstrated a 44% reduction in Gd-enhancing lesions in those who took simvastatin.
Study results—though preliminary—trend toward the possible benefit of simvastatin on MS. Overall, researchers are cautiously optimistic. They are pleased with the fact that simvastatin has been widely used to treat high cholesterol and therefore much is known about its safety profile and mechanism of action. Researchers hope to explore the potential benefits of statins on MS in larger future studies.
Additional links
- Read last month’s eMS News article – Interview with Dr. Hebert.
- Interested in more articles? Subscribe to Rocky Mountain MS Center’s InforMS magazine.