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Lipoic acid in secondary progressive MS: A randomized controlled pilot trial.
Rebecca Spain1, Katherine Powers1, Charles Murchison1
1Neurology Division (R.S., V.Y., M.C., E.K., D.B.), Research Service (K.P., E.H.), and Department of Ophthalmology (K.W.), Veterans Affairs Portland Health Care System, OR; and Department of Neurology (R.S., C.M., K.W., V.Y., E.K., F.H., J.S., D.B.), Advanced Imaging Research Center (K.P.), and Casey Eye Institute (K.W.), Oregon Health & Science University, Portland.
Lipoic acid (LA) significantly slowed brain atrophy in secondary progressive multiple sclerosis (SPMS) patients over two years. This antioxidant demonstrated a 68% reduction in brain volume loss, suggesting clinical benefits and favorable safety.
Area of Science:
- Neuroscience
- Neurology
- Pharmacology
Background:
- Secondary progressive multiple sclerosis (SPMS) is characterized by relentless neurodegeneration and brain atrophy.
- Lipoic acid (LA), an endogenous antioxidant, has potential neuroprotective properties.
- NCT01188811: A clinical trial investigating the efficacy and safety of LA in SPMS.
Purpose of the Study:
- To evaluate the effect of lipoic acid (LA) on the rate of whole-brain atrophy in patients with SPMS.
- To assess the safety and tolerability of daily oral administration of 1,200 mg LA over a 2-year period in SPMS patients.
Main Methods:
- A 2-year, double-blind, randomized, placebo-controlled trial involving 51 SPMS patients aged 40-70 years.
- Primary outcome: Annualized percent change in brain volume (PCBV).
- Secondary outcomes: Rates of atrophy in brain, spinal cord, and retinal substructures, disability, quality of life, and safety assessments; intention-to-treat analysis with linear mixed models.
Main Results:
- The annualized PCBV was significantly lower in the LA group (-0.21%) compared to the placebo group (-0.65%), representing a 68% reduction (p=0.002).
- No significant difference was observed in the Timed 25-Foot Walk test, though a trend towards improvement favored the LA group (p=0.06).
- LA patients experienced more gastrointestinal upset but fewer falls; rare renal adverse events were noted. Compliance was high at 87%.
Conclusions:
- Lipoic acid (LA) significantly reduced brain atrophy in SPMS patients over two years.
- LA demonstrated potential clinical benefits, favorable safety, tolerability, and compliance in this SPMS cohort.
