Fumaric Acid & MS

Imagine there would be an old, cheap and simple drug for a certain condition, which also had some positive effect on MS. Interested? Yes, it exists, but it has lost its patency protection long ago and is so cheap that no medical firm will perform a study of its efficacy and a dose-finding-study with associated consideration of adverse effects. Yes, at least one such drug exists: Fumaric acid esters [FAE] have proven their therapeutic efficacy for decades in psoriasis, a skin disease, as MS belonging to the autoimmune group of diseases. It has since 2006 been reported effective in MS, first in a small study of 10 patients [1] and then in broader clinical studies which so far (Jan. 2012) have not been reported, whatever the reason – also a negative result would be interesting. In addition, it has – as so many
drugs and other substances – been found effective to cure mice and rats for EAE, the experimental blizzard MS (have they tried cheese?).

     Fumaric acid is an intermediate product of the citric acid cycle that is a source of intracellular energy in the form of adenosine triphosphate (ATP). It is thus a substance normally present in human tissues, therefore do not expect too much – and do not fear severe adverse effects. Many studies found an active role in the suppression of damaging humoral factors. A conflicting report [2] found that fumarates have no or only little direct protective effects on oligodendrocytes and may act rather indirectly via the modulation of immune cells. However, in MS-patients, both a reduction of inflammation as protection of nerves has been claimed, also in chronic cases.

    Of course, a lightly changed substance, dimethylfumarate (BG12), possibly beneficial, was created to overcome the vacuum by the potential income of a new drug, especially engineered for treatment of MS. If you are too desperate to wait for the new studies and are willing to accept the unbalanced result when n=1, including possible placebo-effect by discretely improved symptoms, you can use the old preparation (dose increased to 250 mg * 3 or 500 mg * 2).

1    Schimrigk S, Brune N, Hellwig K, Lukas C, Bellenberg B, Rieks M, Hoffmann V, Pöhlau D, Przuntek H. Oral fumaric acid esters for the treatment of active multiple sclerosis: an open-label, baseline-controlled pilot study. Eur J Neurol 2006;13:604-10.
2    Moharregh-Khiabani D, Blank A, Skripuletz T, Miller E, Kotsiari A, Gudi V, Stangel M. Effects of fumaric acids on cuprizone induced central nervous system de- and remyelination in the mouse. PLoS One. 2010;5:e11769.

Inserted  Jan. 23, 2012, Revised Jan. 25