Late Breaking ECTRIMS News. Ibudilast sprints to the lead and shows success in progressive MS

It is time to eat humble pie

Earlier in the year I expressed concern about the use of Ibudilast in MS.

The wait is over and I was possibly wrong, 

It was shown that Ibudilast reduced brain volume loss by 48%. in progressive MS, so supporting the past trial in MS. As we know this agent does not stop relapses and so now the age of progressive MS really changes.

Probably as ProfG says below...we don't know if this effect was clinically meaningful, but at least it's a start.

What happens next?

We are not going to be thinking that the agent is targeting active lesions so this is targeting a different mechanism.

How does this work? 

Ibudilast is a PDE4 phosphodiesterase 4 inhibitor, you can read the post above to show how this works.

Ibudilast is also a macrophage inhibitor, and is this the key? 
We have said for some time that macrophages/microglia are at the centre of the inflammatory response. So their inhibition is a good thing.

Ibudilast will also inhibit tumor necrosis factor, which is a survival factor for plasma cells. So does it stop the production of oligoclonal bands?

Trial details

It was a 28 site trial sponsored by the NIH. The criteria were up to 65 years old, primary and secondary progressive MS. Allowed treatments were beta interferon and glatiramer acetate.  

86% finished the trial and about 5% more people stopped taking Ibudilast.

The main side effects were gastrointestinal problems including pain, vomiting and diarrhoea. There was an increase in rashes and depression. In addition, fatigue was slightly worse, 

A marked effect of magnetization transfer ratio (a measure of  tissue structure integrity) was seen, but no significance was seen with Diffusion tensor imaging .

Well done to All....The MS world changes!

CoI: None

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