August 29, 2018, Cleveland: A promising drug slowed brain shrinkage in progressive multiple sclerosis (MS) by nearly half, according to new research led by Cleveland Clinic. Very limited therapies are currently available for this disabling form of the disease.
The definitive results of the phase 2 trial - published in the New England Journal of Medicine - showed that the drug ibudilast decreased progression of brain atrophy in progressive MS patients by 48 percent versus placebo. The two-year SPRINT-MS study was conducted at 28 sites with 255 patients.
"These findings are significant for patients with progressive MS," said Robert Fox, M.D., the study's principal investigator and vice-chair for research in Cleveland Clinic's Neurological Institute. "Our hope is that the benefit of ibudilast in slowing brain shrinkage will also translate to decreased progression of associated physical disabilities in a future phase 3 trial."
Progressive MS is associated with gradual worsening of symptoms and increasing disability. It commonly follows relapsing-remitting MS, for which there are more than a dozen approved treatments. However, none of these therapies has consistently demonstrated efficacy in slowing disability progression in patients with progressive MS, particularly those without evidence for active inflammation.
Ibudilast, an oral drug with activity on several biologic pathways with potential relevance to progressive MS, was approved in Japan in 1989 for use in asthma and stroke. It is also being studied in the U.S. for potential treatment of amyotrophic lateral sclerosis (ALS) and drug addiction.
Additionally, the SPRINT-MS study demonstrated the utility of advanced imaging in clinical trials to measure the impact of therapies on brain health. The potential application of imaging-based outcome measures may extend beyond progressive MS to other neurodegenerative disorders as well.
"There is a significant need for new treatment options to effectively delay disability progression for patients with progressive MS," said Dr. Fox. "We are hopeful these findings will help us develop more therapies for progressive MS, and do so more rapidly and efficiently."
The research, which paves the way for phase 3 testing, also determined that ibudilast is relatively safe and well tolerated. The drug has received fast-track designation from the U.S. Food & Drug Administration.
"Although a larger study is needed to confirm these findings, this promising study brings people with progressive MS, who currently do not have many treatment options, one step closer to a potential therapy," said Robin Conwit, M.D., program director at the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
The study was conducted by the Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT), which is sponsored by NINDS. The research was supported by NINDS, National Multiple Sclerosis Society and MediciNova.
"These results are a promising step toward a potential new therapy for people living with progressive forms of MS, for whom there are few treatment options," said Bruce Bebo, Ph.D., Executive Vice President, Research, National MS Society. "It is gratifying to see our investments in progressive MS starting to pay off."
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. Among Cleveland Clinic's 52,000 employees are more than 3,600 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic's health system includes a 165-acre main campus near downtown Cleveland, 11 regional hospitals, more than 150 northern Ohio outpatient locations - including 18 full-service family health centers and three health and wellness centers - and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2017, there were 7.6 million outpatient visits, 229,000 hospital admissions and 207,000 surgical cases throughout Cleveland Clinic's health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.
Editor's Note: Cleveland Clinic News Service is available to provide broadcast-quality interviews and B-roll upon request.
New England Journal of Medicine