From the Journals

Frankincense extract may reduce disease activity in relapsing-remitting MS

 

Key clinical point: Standardized oral frankincense extract was safe, well tolerated, and potentially efficacious in patients with relapsing-remitting multiple sclerosis.

Major finding: The median number of monthly contrast-enhancing lesions was significantly reduced from 1.00 at baseline to 0.50 on treatment (P less than .0001).

Study details: The SABA phase 2a trial, an investigator-initiated, open-label, pilot study including 38 patients with RRMS.

Disclosures: The study was funded in part by Alpinia Laudanum Institute, which supplied the standardized frankincense extract at no charge. Individual authors reported competing interests with Alpinia Laudanum, Biogen, Sanofi Genzyme, Novartis, Merck Serono, and others.

Source: Stürner KH et al. J Neurol Neurosurg Psychiatry. 2018;89:330-8.

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New therapeutic option for relapsing-remitting MS?

Results of the SABA phase 2a trial suggest that frankincense could be a new therapeutic agent for mildly disabled young patients with RRMS who require long-term treatment, according to Dr. Francesco Patti.

In the study, administration of standardized oral frankincense extract significantly reduced the median number and volume of contrast-enhancing lesions and the number of new T2 lesions. The treatment also increased brain parenchymal volume and reduced the annualized relapse rate. While disability scores remained unchanged, measures of function and quality of life improved.

The treatment effects also appeared to be durable, based on the extension phase results.

Blood and immunologic findings suggested that the treatment was not toxic and that it exerted immunomodulatory activity by reduction of IL-17–producing CD8-positive T cells, as well as anti-inflammatory properties through inhibitory effects on 5-lipo-oxygenase, microsomial prostaglandin E2 synthase-1, LL-37, and nuclear factor-kB activities.

“This mechanism of action, attributing a role of these enzymes in neuroinflammation, might offer a new therapeutic approach,” he concluded in his editorial.

Francesco Patti, MD , is with the Multiple Sclerosis Hub Center, University of Catania (Italy). These comments are derived from his editorial ( J Neurol Neurosurg Psychiatry. 2018;89:327 ). Dr. Patti declared no competing interests related to the editorial.


 

FROM Journal of Neurology, Neurosurgery & Psychiatry


Patients underwent observation for 4 months, then were treated with the extract for up to 8 months plus an optional extension phase of up to 36 months. A total of 28 patients completed the initial treatment period, and 18 participated in the extension period, according to the study results.

The median number of monthly contrast-enhancing lesions was significantly reduced from 1.00 at baseline to 0.50 during the initial treatment period (P less than .0001). In addition, significantly less brain atrophy was noted after the treatment phase as compared with the baseline observation phase (P = .0081).

Adverse events, mainly infections or gastrointestinal symptoms, were mild (57.7%) or moderate (38.6%), investigators added.

Treatment significantly increased regulatory CD4-positive T cell markers and decreased interleukin-17A–producing CD8-positive T cells, according to results of mechanistic studies that were also reported.

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