WebMD Medical News
Laura J. Martin, MD
Sept. 13, 2010 -- Adding the asthma drug albuterol to a treatment for multiple sclerosis (MS) improved walking ability and delayed the time to first relapse among patients in a newly published study.
Patients starting daily injections of the MS drug glatiramer acetate -- known by the brand name Copaxone -- showed improvement over the course of a year when oral albuterol was added to the treatment regimen.
Those treated with Copaxone and placebo showed slight declines in function after a year of treatment, study researcher Samia J. Khoury, MD, of Harvard Medical School tells WebMD.
The study was small, but Khoury says the findings indicate the inexpensive drug may be a useful addition to early MS treatment.
"I do give albuterol to my patients early in treatment if they don't have contraindications," she says. "It is cheap and generally well tolerated and patients take just one pill a day."
The inhaled form of albuterol is widely prescribed to patients with asthma, COPD, and other pulmonary diseases to open constricted airways.
Khoury and colleagues at Harvard's Brigham and Women's Hospital first considered using albuterol as an additional early treatment for multiple sclerosis almost a decade ago.
That was when the researchers first reported that the asthma drug inhibited production of specific inflammation-causing messenger proteins linked to MS, known as interleukin-12 (IL-12).
High levels of IL-12 have been reported in patients with secondary progressive MS, which is an advanced form of the disease characterized by progressive symptoms and few or no relapses.
Disease-modifying drugs like Copaxone, interferon-beta 1a and 1b, and Tysabri appear to slow the progression from early disease to secondary progressive MS. It is now recommended that patients consider starting these treatments as early as possible following diagnosis.
In the newly reported study, Khoury and colleagues randomly assigned 44 patients with relapsing-remitting MS who had not previously received treatment affecting the immune system to receive daily injections of Copaxone with oral albuterol or a placebo pill for up to two years.
Neurological testing was performed at the beginning of the study and again at three, six, 12, 18, and 24 months. Blood samples were collected four times over the first year. Brain imaging to look for the lesions associated with MS was also performed at enrollment and at 12 and 24 months.
Thirty-nine patients were included in the final analysis. Improvement in functional status was seen in the combined treatment group at six months and a year, but not at two years. Most of the improvement was related to walking and was measured by timing how long it took a patient to walk 25 feet.
Published online today, the study appears in the September issue of the Archives of Neurology.
Treatment with albuterol is generally not recommended for some patients taking beta-blockers or for those with heart palpitations or anxiety, Khoury says.
She adds that MS patients without these contraindications may benefit from taking the drug with disease-modifying therapy during the first year of treatment.
National MS Society spokesman Nicholas LaRocca, PhD, says larger studies are needed to confirm the findings.
"This is a promising study, but it was small," he tells WebMD. "I think it would be premature to recommend adding this to treatment based on one study."
But Khoury says since albuterol is now generic, its manufacturers have little financial incentive to conduct additional research.
As researchers search for new and better MS treatments, LaRocca says taking a closer look at drugs that are already available makes sense.
"The cost of developing new drugs is astronomical," he says. "If there are drugs already out there that are not overly expensive and can be used with the currently available treatments, that is certainly worth exploring."
SOURCES:Khoury, S.J. Archives of Neurology, September 2010; vol 67: pp 1055-1061.Samia J. Khoury, MD, Center for Neurologic Diseases, department of neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.Nicholas LaRocca, PhD, vice president, Health Care Delivery and Policy Research, National MS Society.
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