Can an OTC Allergy Drug Restore Function in Patients with MS?

A phase 2 trial out of the University of California-San Francisco suggests the over-the-counter allergy drug clemastine fumarate may restore nervous system function in patients with multiple sclerosis. Researchers published their findings online in The Lancet (doi: 10.1016/S0140-6736(17)32346-2).

“To the best of our knowledge, this is the first time a therapy has been able to reverse deficits caused by multiple sclerosis,” said principal investigator Ari Green, MD, in a university press release (October 10, 2017). “It’s not a cure, but it’s a first step toward restoring brain function to the millions who are affected by this chronic, debilitating disease.”

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Inspired by previous research that showed clemastine fumarate promoted myelin regeneration and restored neural function in rats, researchers tested the effect of the drug in 50 patients with relapsing multiple sclerosis with chronic demyelinating optic neuropathy. The double-blind trial randomized 25 patients to clemastine fumarate for 90 days followed by placebo for 60 days, and 25 patients to placebo for 90 days followed by clemastine fumarate for 60 days. The crossover design allowed researchers to compare patients to themselves.

To assess the drug’s effect, researchers used visual evoked potentials (VEPs). Participants viewed flickering patterns, and electrodes placed over the brain’s visual areas measured how long it took the viewed flicker to generate an electrical response.

In patients taking clemastine fumarate, the neural signal from the eye to the back of the brain was significantly faster than it was at baseline, researchers found. The improvement persisted after patients who had taken clemastine fumarate first switched over to placebo, suggesting the durability of the myelin repair.

“People thought we were absolutely crazy to launch this trial, because they thought that only in newly diagnosed cases could a drug like this be effective — intuitively, if myelin damage is new, the chance of repair is strong,” said study senior author Jonah R. Chan, PhD. “In the patients in our trial, the disease had gone on for years, but we still saw strong evidence of repair.”

“This is the first step in a long process,” added Dr Green. “By no means do we want to suggest that this is a cure-all. We want to ground-truth myelination metrics. We’re designing the crucible that’s going to be used to test any future method for detecting remyelination.”

—Jolynn Tumolo

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