Statins for treatment of MS

Statins, also called HMG-CoA reductase inhibitors (HMG-CoA is short for 3-Hydroxy-3-methylglutaryl-coenzyme A), are widely used in the US and Europe to treat elevated cholesterol levels in the blood. These drugs, which include Lipitor (atorvastatin) and Zocor (simvastatin), are among the most frequently prescribed medications in the US.

 
In addition to acting on cholesterol, statins may have an anti-inflammatory effect by blocking pro-inflammatory cytokines and decreasing B-cell and T-cell chemokine receptors (T and B cells are types of lymphocytes or white blood cells with important immune system functions). This is why statins, alone and in combination with other MS drugs, have been tested for their effectiveness in treating MS.

 

Results from clinical studies of two different statins (atorvastatin and simvastatin) alone or in combination with other treatments in MS have been inconclusive.

In a small Phase 2 open-label study, simvastatin (80 mg) resulted in a significant decrease in the number and volume of new gadolinium (Gd)-enhancing lesions on magnetic resonance imaging (MRI). Another study conducted in 41 people with MS found that atorvastatin had a similar beneficial effect, with Gd-enhancing lesions decreased during the treatment phase compared with an earlier lead-in phase of the study. Some people in this study were also receiving interferon beta-1a treatment, so the combination of treatments may have been responsible for decreases in number and volume of lesions.

A post hoc analysis of data from the SENTINEL (Safety and Efficacy of NaTalizumab in Combination With INterferon Beta-1a in Patients with RELapsing-Remitting Multiple Sclerosis) trial found that statin therapy does not have an effect on clinical outcomes associated with interferon beta-1a treatment. Of the participants in the SENTINEL trial who received singular treatment with interferon beta-1a (n=582), 40 patients were already taking statins to treat high cholesterol levels. No significant differences were observed between the no-statin group and the statin group in annual rate of relapse, progression of disability, or number of new Gd-enhancing lesions.

A systematic review of randomized, controlled studies comparing statins with placebo, or comparing statin therapy alone and in combination with approved MS treatments (interferon beta-1a), failed to find any significant differences in frequency of relapse, progression of disability, or number of Gd-enhancing lesions between statin treatments (atorvastatin and simvastatin) and placebo, or between statins combined with interferon beta-1a, and interferon beta-1a taken alone.

While these studies found no convincing evidence to support using statin therapy alone or in combination with approved disease-modifying treatments in MS, the number of well designed studies was small. Several additional studies of statins are currently underway and may provide additional relevant information about the usefulness of these medications in MS.

Written by: Jonathan Simmons | Last reviewed: May 2015.
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