Estriol Reduced Multiple Sclerosis Relapses

Professor Rhonda Voskuhl, M.D. Jack H. Skirball Chair in MS Research Director of the UCLA MS Program David Geffen School of Medicine University of California, Los Angeles

Prof. Voskuhl

MedicalResearch.com Interview with:
Professor Rhonda Voskuhl, M.D.
Jack H. Skirball Chair in MS Research
Director of the UCLA MS Program
David Geffen School of Medicine
University of California, Los Angeles

Medical Research: What is the background for this study? What are the main findings?

Dr. Voskuhl: It had been known for decades that relapses were reduced during pregnancy in women with Multiple Sclerosis (MS), psoriasis and rheumatoid arthritis. We viewed this as a major clue to help find new disease modifying treatments. Focusing on MS, we investigated treatment with estriol, an estrogen that is made by the fetus/placenta during pregnancy. Preclinical studies and a pilot clinical trial at UCLA showed good results leading to the current Phase 2 clinical trial at 16 sites across the U.S. It showed that treatment with estriol pills compared to placebo pills, each in combination with standard of care (glatirmar acetate) injections, reduced relapses by one third to one half over and above standard of care treatment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Voskuhl: Estriol is known as the safest of the estrogens and has been taken for menopausal symptoms through Europe and Asia for decades, so its side effects are well studied. However, the dose for menopause is 1-2 mg per day, while the pregnancy dose used for  Multiple Sclerosis in our trials is 8 mg. Even though the trial showed that estriol was safe at this dose for 2 years, larger studies are needed at this dose to monitor safety. The threshold for tolerance of toxicity is higher for patients like Multiple Sclerosis that have a disabling disease as compared to healthy menopausal women where very little toxicity is acceptable. But until larger studies are done that confirm efficacy of estriol for MS, patients should not start taking estriol for their MS.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Voskuhl: A larger study is needed to confirm our effect of estriol treatment on reducing relapse rates. If confirmed, trials in psoriasis, rheumatoid arthritis and other autoimmune diseases that improve during pregnancy are warranted. Exciting other findings in our trial suggested potential benefits of estriol treatment to improve cognition and reduce fatigue. These findings warrant additional trials that focus on these disabilities. One such trial is now recruiting at UCLA, U. of Colorado, U. of Pennsylvania and U. of New Mexico. For more information check out our website at:

http://neurology.ucla.edu/research/programs/multiple-sclerosis

Citation:

Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial

Voskuhl, Rhonda R et al.

The Lancet Neurology
DOI: http://dx.doi.org/10.1016/S1474-4422(15)00322-1

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Professor Rhonda Voskuhl, M.D (2015). Estriol Reduced Multiple Sclerosis Relapses 

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