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The authors of this small and preliminary study showed that albuterol, prescribed for a variety of respiratory illnesses, enhances the effects of glatiramer acetate, a drug already prescribed for MS patients.
Because albuterol is known to reduce a substance in the body connected to the onset of MS, doctors at Harvard looked at using the drug as an add-on treatment.
Study author Dr. Samia J. Khoury said the study was designed to see if the drug helped reduce symptoms of the inflammatory disease.
"Albuterol causes the [immune system] cells to change the type of interleukin they produce to one that is beneficial in MS," said Khoury, a professor of neurology at Harvard Medical School and Brigham and Women's Hospital in Boston. "The idea was that albuterol may enhance the effect of Copaxone [glatiramer acetate], and this was confirmed in the study."
Interleukins are molecules that enable cells to communicate with one another. They promote or reduce the growth of cells involved in the inflammatory process that is thought to drive MS.
Multiple sclerosis attacks the brain and spinal column and can affect muscles throughout the body, resulting in problems walking, breathing, and speaking, according to the U.S. National Institutes of Health (NIH).
The disease destroys the protective myelin sheath surrounding nerve cells, leading those cells to eventually shut down. Usually diagnosed in early adulthood, it is estimated to cost billions each year in the United States. It affects twice as many women as men, and is five times more likely to be found in temperate climates, according to the NIH.
Multiple sclerosis usually goes into remission and relapses in unpredictable cycles. Except in severe cases, people with multiple sclerosis have a normal life expectancy and live fairly normal lives when treated, experts said.
Experts believe that a combination of genetic and environmental factors cause the disease. A variety of viruses have been looked at, but no evidence supporting a role in the disease has been found for any of them, according to the NIH.
In the study, 44 newly diagnosed patients were assessed when they began treatment with glatiramer acetate using the Multiple Sclerosis Functional Composite, a scale measuring leg, arm and hand function, along with mental function. It found improvement in the study group mainly in the leg function, or timed 25-foot walk, within the first year. This is important because glatiramer acetate can take a while to start working and albuterol was found to enhance its efficacy in the first year, Khoury explained.
Neither patients nor doctors knew who received albuterol, a drug with few side effects. Five participants dropped out, leaving 39 patients for the final analyses of the data.
Brain imaging showed reduced inflammation after treatment in both groups, with no significant difference between the study group and the control group.
Dr. Tracy M. DeAngelis, an assistant professor at the Corinne Goldsmith Dickinson Multiple Sclerosis Center at Mount Sinai Medical Center in New York City, said the study was important because existing treatments for the disease are limited.
"FDA-approved therapies are all only partially effective," said DeAngelis. "We don't have any 100% effective therapies for MS, so using a combination of therapies with an already approved drug with a good safety record is very exciting."
DeAngelis noted the study also found fewer annual relapses for the treatment group as well as a delay in "time to first relapse."
Noting the small size of the study, DeAngelis said "what is needed now is a large, multi-center study in order to draw any conclusion" about whether albuterol should be used in the normal course of treating multiple sclerosis.
She said, a large study with yearly "relapse rates or MRI activity as the primary endpoints" is needed because these will better measure the efficacy of the combination treatment.
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