Statin appears to inhibit secondary progressive stage of multiple sclerosis

by Bruce Sylvester – Researchers report that simvastatin could become a treatment option for the secondary progressive, or chronic, stage of multiple sclerosis (MS).

Findings from the phase 2 MS-STAT trial appeared in The Lancet on March 18, 2014.

“In the progressive stage of MS the brain shrinks by about 0.6% a year. Our main measure of success was to reduce the rate of brain atrophy”, said lead investigator Dr. Jeremy Chataway of University College London Hospitals, in London, UK.

The investigators found that daily high-dose simvastatin slowed brain atrophy by 43% over two years compared with placebo.  Longitudinal studies have suggested that worsening atrophy correlates to increasing disability.

As background, the authors noted that early-stage MS is produces intermittent neurological symptoms, called relapsing-remitting MS. Within 10 to 15 years, more than half of patients develop secondary progressive MS, with worsening symptoms and increasing disability.

There is currently no effective drug therapy for secondary progressive MS.

The MS-STAT trial investigators randomized 140 people with secondary progressive MS (aged 18-65 years) to receive either 80 mg of simvastatin or placebo for 2 years.

Pre-treatment and post-treatment brain MRI scans indicated a drop in the average rate of atrophy to 0.3% a year with simvastatin, a 43% reduction (when adjusted for factors such as age and gender) compared with placebo.

They also found significant improvements in doctor-reported (EDSS) and patient-reported (MSIS-29) disability scales.

Simvastatin was generally well tolerated, and serious adverse event rates were similar, 20% placebo vs 13% simvastatin.

In a linked Lancet Comment, Dr. Jacqueline Palace from the John Radcliffe Hospital, Oxford, UK and Dr. Neil Robertson from Cardiff University in Wales said, “Chataway and colleagues’ study is a promising and novel development. The study is investigator led and has therefore focused on clinical need, targeting patients with progressive multiple sclerosis in whom most disability is incurred…The study also reports a predominant effect on neurodegenerative rather than inflammatory outcomes, suggesting a novel mechanism of action that might be suitable as combination treatment with immunomodulatory treatments…Further phase 3 studies to measure the effect of simvastatin on sustained disability, particularly in patients with non-relapsing secondary progressive and primary progressive multiple sclerosis, are clearly needed, but this trial represents a promising point from which to develop trials of progressive disease.”