Metformin and pioglitazone showed anti-inflammatory effects in patients with multiple sclerosis and metabolic syndrome, according to a new study published in JAMA Neurology.
Metabolic syndrome may affect some autoimmune diseases, including multiple sclerosis. Metformin HCl and pioglitazone, which are used to in metabolic syndrome, exert anti-inflammatory effects but evidence to support their use in multiple sclerosis has been insufficient.
Laura Negrotto, MD, and colleagues from the Institute for Neurological Research Dr Raul Carrea, Buenos Aires, Argentina, conducted a prospective cohort study to determine whether metformin and/or pioglitazone are associated with a reduction in disease activity as measured by brain MRI in patients with multiple sclerosis and metabolic syndrome. The study included 50 obese patients with multiple sclerosis who also developed metabolic syndrome.
Twenty patients received metformin HCl 850–1500mg/day and 10 patients received pioglitazone HCl 15–30mg/day; 20 untreated patients served as controls. Patients were followed up for a mean of 26.7 months. Brain MRIs were taken at 6-month intervals and serum leptin and adiponectin levels were measured.
After 6 months of treatment, 20 patients with multiple sclerosis treated with metformin and 10 treated with pioglitazone had a significant reduction in the number of new or enlarging T2 lesions: metformin (2.5 at study entry vs. 0.5 at Month 24); pioglitazone (2.3 at study entry vs. 0.6 at Month 24). Also, there was a a reduction in gadolinium-enhancing lesions for patients treated with metformin and pioglitazone: metformin (1.8 at study entry vs. 0.1 at Month 24); pioglitazone (2.2 at study entry vs. 0.3 at Month 24).
Mean leptin levels were lower in both treatment arms compared to controls; an increase in mean adiponectin serum levels was also seen with both treatments (both P<0.001). Mean number of myelin basic protein peptide-specific cells secreting interferon gamma and interleukin (IL)-17 were significantly lower in patients receiving metformin vs. controls (P<0.001). Treatment with pioglitazone showed significant decreases in mean number of myelin basic protein peptide-specific cells secreting IL-6 and TNF vs. controls (P<0.001).
The authors concluded that “treatment with metformin and pioglitazone has beneficial anti-inflammatory effects in patients with MS and MetS and should be further explored.”
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