This article is more than 5 years old. Information may no longer be current.
Metformin, pioglitazone reduce inflammation in multiple sclerosis with metabolic syndrome
Click Here to Manage Email Alerts
In patients with multiple sclerosis who have metabolic syndrome, treatment with metformin and pioglitazone decreases disease activity exhibited on MRI, according to recent findings.
In a prospective cohort study, Jorge Correale, MD, head of neuroimmunology and demyelinating diseases at Dr. Raúl Carrea Institute for Neurological Research in Buenos Aires, and colleagues evaluated 50 patients with obesity (BMI ≥ 30 kg/m2) and confirmed relapsing-remitting multiple sclerosis (MS; defined according to 2010 McDonald criteria) who developed metabolic syndrome (defined according to WHO criteria). Researchers assigned 20 patients to treatment with metformin 850 to 1,500 mg daily and 10 patients to pioglitazone 15 to 30 mg daily; 20 patients not treated for metabolic syndrome served as a control group. The cohorts were similar in sex, age, BMI, Expanded Disability Status Scale score, duration of disease, annual rate of relapse and treatment status.
Jorge Correale
Patients were followed for a mean 26.7 months. Every 3 months, patients underwent a comprehensive neurologic examination, which included physical evaluation of disease activity and estimated Expanded Disability Status Scale score. Patients also underwent immunologic testing during the last 18 to 24 months of follow-up. Blood samples were taken at baseline and after 18 months to evaluate adipokine and leptin levels. Patients underwent MRI brain imaging at 6-month intervals to identify new or enlarging T2 or gadolinium-enhancing lesions. Researchers assayed the production of cytokines by peripheral blood mononuclear cells and also tested regulatory T-cell numbers and function.
Compared with baseline, the metformin group showed a reduction at month 24 in the number of new or enlarging T2 lesions (2.5 vs. 0.5) and gadolinium-enhancing lesions (1.8 vs. 0.1). The pioglitazone group had a reduction in the number of new or enlarging T2 lesions (2.3 vs. 0.6) and gadolinium-enhancing lesions (2.2 vs. 0.3). Compared with controls, treated patients showed reductions in mean leptin levels and increases in mean adiponectin levels (P < .001 for all). Compared with controls, the metformin group had a decrease in the mean number of myelin basic protein peptide-specific cells secreting interferon-gamma and interleukin-17 (P <.001). The pioglitazone group had reductions in the mean number of myelin basic protein peptide-specific cells secreting IL-6 and tumor necrosis factor vs. controls (P < .001). Patients on both medications showed increases in the numbers and regulatory functions of CD4+CD25+FoxP3+ regulatory T cells compared with controls (P = .001 for each).
“All comorbidities associated with multiple sclerosis should be treated, improving the prognosis of the disease (hypertension, cardiovascular diseases, diabetes, thyroid disorders, obesity, metabolic syndrome, etc.), Correale told Endocrine Today. “Both drugs showed an anti-inflammatory effect in these patients; however, these data cannot say yet whether it is a product of the drug per se or a result of the improvement of metabolic syndrome.”– by Jennifer Byrne
Disclosure: Correale reports serving as a board member for and receiving reimbursement for educational programs and travel from Biogen-Idec LATAM, Genzyme Global, Genzyme LATAM, Merck-Serono Agentina, Merck-Serono LATAM and Novartis Argentina, and receiving reimbursement for educational programs and travel from TEVA Argentina. Please see the full study for a list of relevant disclosures.
Click Here to Manage Email Alerts