Imuran Stops New Brain Lesions in MS Patients

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Imuran Stops New Brain Lesions in MS Patients

By Jeff Minerd , MedPage Today Staff Writer

Reviewed by Jasmer, MD; Assistant Professor of Medicine,

University of California, San Francisco

MedPage Today Action Points

Consider Imuran (azathioprine) as an alternative to other

immunosuppressive drugs in treating relapsing-remitting MS,

especially in patients for whom tolerance of their current treatment

is an issue.

Review

FLORENCE, Italy, Dec. 13 - For relapsing-remitting multiple sclerosis

(MS), the immunosuppressant Imuran (azathioprine) reduces new brain

lesions, according to a small study here

After six months of daily treatment, the number of new brain lesions

was reduced by 50% or more in a majority of the 14 patients, Luca

Massacesi, M.D., and colleagues at the University of Florence here

reported in the December issue of the Archives of Neurology.

Originally approved by the FDA in 1968, Imuran is indicated for renal

transplant patients and for rheumatoid arthritis. While previous

studies have suggested the drug may be clinically useful for MS, none

has examined its effect on the development of new brain inflammatory

lesions, the researchers said.

The open-label study included 10 women and four men with relapsing-

remitting MS and at least three gadolinium-enhancing (Gd+) brain

lesions observed within six months before treatment. The patients

ranged in age from 23 to 53, and they had the disease for a range of

one to nine years.

Patients received up to 3 mg/kg of the drug per day orally, with dose

adjusted according to blood lymphocyte count. Brain lesions were

evaluated monthly by MRI for six months before treatment, during the

six months of treatment, and for an additional six-month extension

period.

The main outcome measure was reduction of the number and volume of

new Gd+ brain lesions. A secondary outcome was reduction in number

and volume of new T2 lesions. Key results included:

After six months of treatment, 12 of the 14 patients had a 50% or

more reduction in the number and volume new of Gd+ lesions (P<0.01).

Also at six months of treatment, nine of the 15 patients had about a

50% or more reduction in number and volume of new T2 lesions. (P<0.01).

Mean lymphocyte count of the patients fell to 57% of baseline levels,

which showed that the drug was biologically active.

These results were maintained during the six-month extension period.

Six patients had adverse events at the start of therapy, but these

were transient or reversed after a dose reduction, the researchers

said, noting that no patient interrupted therapy. The treatment was

well tolerated for the remaining one year of the study, they said.

Many other drugs with demonstrated efficacy against MS are not well

tolerated, so better-tolerated alternatives are needed, the study

authors said.

" If considered in the context of previous clinical trials, the

present study indicates that azathioprine may represent an

alternative to immunomodulatory medications specifically approved for

relapsing-remitting MS, " they concluded.

Primary source: Archives of Neurology

Source reference:

Massacesi L et al. Efficacy of azathioprine on multiple sclerosis new

brain lesions evaluated using magnetic resonance imaging. Archives of

Neurology. 2005; 62:1843-1847.

http://www.medpagetoday.com/Neurology/MultipleSclerosis/dh/2319

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> Imuran Stops New Brain Lesions in MS Patients

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As usual, you manage to bring up the most interesting information. I will

talk with my Neurologist at my next appointment. This is promising news,

and although it might not be the drug for me, there could be someone out

there that benefits from it.

Happy Holidays!