Minocycline, a common acne medication, can slow the progress of relapsing-remitting multiple sclerosis (MS) in people who have recently experienced their first symptoms, according to a study from researchers at the University of Calgary’s Hotchkiss Brain Institute.
The unexpected discovery the discovery is significant as it offers a safe and affordable treatment option for those with early onset MS. This discovery could impact thousands of newly diagnosed MS patients around the world.
The Phase 3 clinical trial included 142 participants between the ages of 18 and 60 across 12 Canadian sites including: Vancouver, Burnaby, Calgary, Edmonton, Winnipeg, Ottawa, Toronto, London, Montreal, Quebec City and Halifax.
MS is thought to be an autoimmune disease of the central nervous system. The disease attacks myelin, the protective covering of the nerves, causing inflammation and often damaging the myelin. The drug works by reducing the inflammation.
In Canada, the cost of current therapies for relapsing-remitting MS typically falls in the range of $20,000 to $40,000 per year; the minocycline treatment would cost a fraction of that at about $600 per year.
In the United States, MS treatment often costs about three times as much as in Canada. Researchers say the potential cost saving will be tremendous and will improve access to treatment for people with MS.
Researchers and doctors are excited about the discovery, as there are no oral therapies approved in Canada for use at this very early stage of the disease. The drug itself has been around for 50 years, and it doesn’t need further Health Canada approval to be used as an off label prescription for MS.
“The clinical results are compelling. Based on these findings, neurologists will be able to prescribe minocycline for people experiencing their first symptoms of demyelination if an MRI suggests the cause will likely prove to be MS,"
says HBI member Dr. Luanne Metz, the study’s lead author, who is also a professor in the Department of Clinical Neurosciences at the CSM and an Alberta Health Services neurologist.
“Patients will now have yet another treatment option, one that does not require injections, monitoring lab work, or special authorization by their insurance company; provided they have adequate coverage to begin with. These processes can delay treatment initiation for three to four months whereas minocycline can be started immediately."
This remarkable outcome for individuals experiencing demyelinating symptoms worldwide has been over 18 years in the making.
Neuroscientist V. Wee Yong, PhD, a study author from the HBI and professor in the Department of Clinical Neurosciences, initially had the idea to test the acne medicine in an animal model since minocycline has many anti-inflammatory properties that he thought could be useful in treating MS.
Soon after obtaining successful research results, in studies also supported by the MS Society of Canada and MSSRF, Yong teamed up with Metz who led the transition into a pilot clinical trial, then a Phase 2, and finally the definitive Phase 3 trial.
“This study highlights the benefits of evaluating existing therapies for other indications. Minocycline is an existing acne medication which is safe, and well-tolerated and it is available for immediate clinical use,"
The trial was funded by the Multiple Sclerosis Society of Canada and its affiliated Multiple Sclerosis Scientific Research Foundation (MSSRF). Participants in the trial who were experiencing their first demyelinating symptoms were randomized to receive 100 mg twice daily of the oral minocycline or placebo.
Over six months of treatment, there was a 27.6 per cent reduction of becoming full blown MS. (The risk was 61 per cent in the placebo group and 33.4 percent in the minocycline group.) This is similar to the effects of current therapies.
Luanne M. Metz, M.D., David K.B. Li, M.D., Anthony L. Traboulsee, M.D., Pierre Duquette, M.D., Misha Eliasziw, Ph.D., Graziela Cerchiaro, Ph.D., Jamie Greenfield, M.P.H., Andrew Riddehough, B.Sc., Michael Yeung, M.D., Marcelo Kremenchutzky, M.D., Galina Vorobeychik, M.D., Mark S. Freedman, M.D., Virender Bhan, M.D., Gregg Blevins, M.D., James J. Marriott, M.D., Francois Grand’Maison, M.D., Liesly Lee, M.D., Manon Thibault, M.D., Michael D. Hill, M.D., and V. Wee Yong, Ph.D., for the Minocycline in MS Study Team Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis N Engl J Med 2017; 376:2122-2133June 1, 2017DOI: 10.1056/NEJMoa1608889
Image: Demyelination by MS. Credit: Marvin 101/Wikipedia