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Cholesterol Drug May Offer Hope for MS Patients

It seems to halt progression of the degenerative nerve disease

TUESDAY, April 1, 2003 (HealthDayNews) -- A commonly prescribed cholesterol medication may put the brakes on progression of the degenerative nerve disease multiple sclerosis (MS).

The cholesterol-lowering drug Zocor (simvastatin) appears to inhibit enzymes that play a role in the development of inflammatory lesions in the central nervous system. In doing so, it seems to halt the recurrence of symptoms in the most common type of MS, say researchers from both Yale University and the Barrow Neurological Institute in Phoenix.

"What is really exciting about this treatment is that it targets only that area of the immune system that is directly related to MS. So, you don't get the kind of overall immune suppression you might have with other treatments," says neurologist and study author Dr. Timothy Vollmer, who presents the findings April 1 at the American Academy of Neurology's annual meeting in Honolulu.

Currently, the only accepted treatment for MS is interferon, an injectable drug that does halt symptoms, but also suppresses a good portion of overall immune function and can have serious side effects, experts say. While previous studies have looked at other cholesterol-lowering drugs in the "statin" family, Vollmer says this is the first to use magentic resonance imaging (MRI) to study the effects of simvastatin.

While the research on simvastatin is promising, some experts caution against putting too much hope in what is still considered very preliminary data.

"We don't know, for example, if any health complications would occur if patients who had normal cholesterol took a cholesterol-lowering drug for a long period of time, or what the long-term effects of using this medication would generally be on an MS patients," says Patricia O'Looney, director of Biomedical Research Programs for the National Multiple Sclerosis Society.

Currently, says O'Looney, there's no evidence that MS patients are at any greater risk for high cholesterol. And, she adds, "we need more research on larger groups of patients before this could be considered a viable treatment for MS." As such, she does not recommend that MS patients take cholesterol medications unless they're undergoing treatment for high cholesterol.

Vollmer, chairman of neurology at the Barrow Neurological Institute, agrees, but feels confident of the study results thus far.

"When used in patients with normal cholesterol, this drug does not appear to reduce levels any further. And with the large number of people using the drug long term for the treatment of cholesterol, the overall safety profile seems good," Vollmer says.

MS is a degenerative nerve disease that affects approximately 250,000 Americans, mostly women. It's characterized by lesions in the brain and the spinal cord and attacks on the myelin sheath -- a thin coating that covers all nerves and helps relay messages of movement and sensation from the body to the brain.

The most common form of MS is called "relapsing-remitting." It is characterized by symptoms or attacks that are followed by periods of partial or complete regression for weeks, months or even years. It is during this "quiet time" that Vollmer says simvastatin works to "decrease the risk of major neurological problems from recurring down the road."

The multi-center trial recruited 45 patients, aged 18 to 55, who had been diagnosed with relapsing-remitting multiple sclerosis at least five years before. All had normal cholesterol levels.

Each patient underwent an MRI scan to determine the number and size of brain lesions already present -- damage that is generally a marker of both the severity and progression of MS.

Thirty patients were ultimately enrolled in the treatment phase, with 27 completing the six-month course during which they took 80 milligrams of oral simvastatin once a day. During this time, the patients received numerous neurological assessments, as well as multiple MRI exams and blood tests that measured, among other things, their cholesterol levels.

The end result: "At the end of six months we saw a 43 percent decrease in the number of inflammatory events that were occurring in the brain, as measured by the MRI, in those who were taking the simvastatin," Vollmer says.

While he believes past experience shows this finding is considered solid evidence of the usefulness of a drug over time, more testing is needed before the therapy can be said to have true clinical significance, Vollmer says.

It's also important to note that simvastatin is not free of side effects. In patients using this drug for cholesterol control, there is an increased risk of gastrointestinal upset, heartburn and headaches. In rare instances, simvastatin can lead to severe muscle weakness and damage.

More information

To learn more about MS, visit The National Multiple Sclerosis Society. To learn more about simvastatin, visit the Cleveland Clinic.

SOURCES: Timothy Vollmer, M.D., chairman, neurology, Barrow Neurological Institute, Phoenix; Patricia O'Looney, Ph.D., director, Biomedical Research Programs, National Multiple Sclerosis Society, New York City; April 1, 2003, presentation, American Academy of Neurology annual meeting, Honolulu
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