Long used in the battle against cardiovascular disease, statins have been hailed as a “wonder drug” for sufferers of Multiple Sclerosis (MS). This debilitating condition affects the brain and spinal cord of 1 in 600 of the population. Despite years of research, the exact cause of why it occurs is still unclear.
Researchers in the MS-STAT trial focused on 140 MS patients with secondary progressive MS. The aim was to see whether the anti-cholesterol drug, Simvastatin, effects the rate of brain shrinkage (atrophy) in MS patients. This was achieved by taking MRI images of the patient’s brain before and after the trial period of 24 months. From these images, the volume of each patient’s brain was measured. The difference between the images was calculated to work out the rate of yearly brain atrophy.
Statins slow brain shrinkage
The researchers identified a difference of 0.25% between the rate of volume loss in the statin and placebo groups. This means that Simvastatin, when compared to no treatment, maintains the volume of the brain by a quarter of a percent. The mechanism behind this is thought to be related to the effects of statins on the vascular system, rather than on the nerves themselves. The researchers also identified fewer white spots on the MRIs of patients in the statin group. These white spots correlate with areas of sclerosis (Greek for “hardening”) which indicates myelin loss in MS sufferers.
What is MS?
Multiple Sclerosis is an autoimmune inflammatory condition of neurological (nerve) cells. The condition is thought to be caused by a stimulus, usually a virus, which triggers an attack by the immune system. The target of this attack is the myelin sheath which is a collection of fibres surrounding the body of each nerve. Myelin acts as an insulator, much like the plastic covering of a wire, aiding efficient transfer of electrical signals which the nerves transmit. When this covering is damaged the electrical signal is only partially transmitted. This leads to complaints of visual loss, muscle spasms and pain from sufferers. An attack comprising of any of these symptoms is described as a relapse.
Multiple relapses occur over a number of years. There are also “remission phases” when the symptoms subside. This stage is known as relapsing and remitting which lasts around 15 years. After this point, patients might experience frequent relapses with only partial remission. This is known as the secondary progressive phase in which the patient gets worse with every relapse and does not fully recover. This is the phase of the disease that the trial focuses on.
What does this mean for the future?
Statins are cheap drugs that are commonly used. They are widely available, with a low side effect profile. If they are able to reduce brain atrophy by the rate described over 2 years, then long term they could have a significant effect. This could go beyond managing patients with MS. It may have some impact for patients with other neurovascular diseases such as vascular dementia. The next phase of the trial is needed to see how effectively simvastatin controls brain atrophy in larger groups of patients. The research group predicts this will take a further six years to complete. A larger amount of data will help to decide if the changes noted on MRI imaging corresponds to an improvement in disability.
How to conduct a trial: The importance of compliance
In the context of a trial it is important to ensure that there is a high compliance rate. In this trial 75% of patients in both groups took the tablets when they were supposed to. Patients were deemed as compliant with their medications when they were taken 90% of the time. Given that compliance rates worldwide for chronic diseases can be as low as 50%, these rates are quite impressive.
At Trusted Medicine we want to help the public by sharing Health and Science News and Research. We love what we do, but we need your help to reach others. Please share our work.If you want to connect with us, please see below. Article proofed and edited for publication by Dr Hannah Arnstein
Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.
Sources and Further Reading
- https://patient.info/health/preventing-cardiovascular-diseases (information on prevention of cardiovascular disease)
- https://trustedmedicine.net/2017/05/08/symptoms-in-the-mind-trusted-medicine/ (article on side effects of statins)
- https://patient.info/health/multiple-sclerosis-leaflet (patient information leaflet on multiple sclerosis)
- http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62242-4/abstract (abstract of phase 2 of the MS-STAT trial)
- https://www.mssociety.org.uk/what-is-ms/types-of-ms/secondary-progressive-spms (information on the secondary progressive stage of MS)
- https://trustedmedicine.net/2017/05/20/eat-mediterranean-live-longer/ (article on the Mediterranean diet and how it improves levels of good cholesterol in the body)
- https://www.mssociety.org.uk/ms-research/treatments-in-the-pipeline/simvastatin (easy explanation of the MS-STAT trial)
- http://www.nhs.uk/conditions/mri-scan/Pages/Introduction.aspx (information MRI scans from the NHS)
- http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/overview_of_the_vascular_system_85,P08254/ (overview of the vascular system from Johns Hopkins University)
- https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022678/ (description of a neurone)
- http://www.nationalmssociety.org/What-is-MS/Definition-of-MS/Myelin (description of myelin function)
- https://medlineplus.gov/viralinfections.html (what viruses are)
- https://medlineplus.gov/ency/article/000821.htm (what is immunity?)
- https://www.mssociety.org.uk/what-is-ms/types-of-ms/relapsing-remitting-rrms (explanation of the relapsing-remitting phase of MS)
- http://www.nhs.uk/conditions/cerebrovascular-disease/Pages/Definition.aspx (explanation of different types of neurovascular disease from the NHS)
- https://www.alzheimers.org.uk/info/20007/types_of_dementia/5/vascular_dementia (explanation of vascular dementia from the Alzheimer’s Society UK)
- http://www.hopkinsmedicine.org/IBDsymposium/Presentations_2013/Medication_Adherence.pdf (Slide show on adherence vs compliance from Johns Hopkins)
- http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf (WHO’sreport on medication adherence from 2003)