Drug Combo Helpful in MS

Researchers found that treatment with metformin and pioglitazone could be beneficial for patients with multiple sclerosis (MS) and metabolic syndrome (MetS). The findings were in a study recently published in the Journal of the American Medical Association Neurology written by Laura Negrotto, MD, of the Department of Neurology at the Institute for Neurological Research in Buenos Aires, Argentina, and appeared online on March 7, 2016.

This prospective cohort study ran from March 1, 2012 to December 30, 2014 and included 50 patients recruited from a private referral center. Each of the participants had MS, were obese and had developed MetS. Twenty of the patients received metformin hydrochloride, 10 received pioglitazone hydrochloride, and 20 were untreated controls.

The researchers say, “Two years before starting the treatment with metformin or pioglitazone, there were no significant differences between the 3 study cohorts in the number of new or enlarging T2 lesions or gadolinium-enhancing lesions as confirmed by brain magnetic resonance imaging (MRI).”

Both the metformin and the pioglitazone groups “showed a significant decrease in the number of new or enlarging T2 lesions on brain MRI compared with the control group and with MRIs performed 2 years before the start of the study,” the researchers reported. Similar results occurred on gadolinium-enhancing lesions. However, there were no significant differences in annualized relapse.

The authors said, “To assess possible mechanisms through which metformin and pioglitazone reduced inflammatory activity as measured by brain MRI, serum levels of leptin and adiponectin were determined.” Recent research has indicated there may be a relationship between leptin and adiponectin and autoimmune diseases, obesity, and MetS. Indeed, the researchers report, “Metformin and pioglitazone treatments resulted in decreased leptin serum levels and increased adiponectin levels.”

The small number of study participants represents a limitation of this study, as well as the nonrandomized and open label design. However, the researchers conclude, “Further investigation in the field is warranted to improve the management of MS and treatment results.”