University of Cambridge scientists ‘on brink of new class of MS treatments’

Cambridge scientists say they are “on the brink of a new class of treatments” to stop the progression of multiple sclerosis (MS).

They believe that within a decade we could see the first licensed treatment that repairs myelin - the protective coating around nerves that is damaged in MS, causing symptoms such as fatigue, pain, spasms and problems with walking.

Early findings of a phase two clinical trial combining metformin, a common diabetes drug, and clemastine, an antihistamine, indicate that it can help repair myelin.

The researchers at the University of Cambridge’s Department of Clinical Neurosciences stress that people should not attempt to acquire the drugs outside a clinical trial, as further research is needed to understand their efficacy and safety in MS.

“I am increasingly sure that remyelination is part of the solution to stopping progressive disability in MS,” said Dr Nick Cunniffe, a clinical lecturer in Neurology at Cambridge, who led the CCMR-Two trial, funded by the MS Society.

“We still need to research the long-term benefits and side effects before people with MS consider taking these drugs. But my instinct is that we are on the brink of a new class of treatments to stop MS progression, and within the next decade we could see the first licensed treatment that repairs myelin and improves the lives of people living with MS.”

Previous evidence from animal studies showed metformin enhances the effect of clemastine on myelin repair.

Until now, however, the two drugs had not been tested together in people.

The early findings of the trial were presented on Friday (26 September) at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), one of the world’s biggest MS research conferences.

Seventy people with relapsing MS took part in the trials for six months, with half taking the drug combination and half taking a placebo.

The primary outcome used to gauge the effectiveness of the drug was a ‘visual evoked potential’ test measuring how quickly signals travel between the eyes and the brain. The speed of signals slowed down in the placebo group over the course of six months, but remained constant in the drug group.

Although this was positive, scientists pointed out that people did not feel better on the drugs.

Myelin repair insulates and protects damaged nerves, preventing them from degenerating over years.

The researchers believe that drugs that promote remyelination will have an long-term effect on disability, which will be the subject of further research.

More than 150,000 people live with MS in the UK.

There are about 20 disease-modifying therapies for people with relapsing MS, and some emerging for active progressive MS, but tens of thousands of people remain without effective treatment.

Existing drugs work only on one aspect of the condition – the immune system - and do not stop the gradual nerve damage that leads to long-term disability.

Protecting nerves by boosting the body's natural ability to put myelin back onto them offers real promise.

Dr Emma Gray, director of research at the MS Society, said: “We desperately need ways to protect nerves from damage and repair lost myelin, and this research gives us real hope that myelin repair drugs will be part of the armoury of MS treatments in the future. These results are truly exciting, and could represent a turning point in the way MS is treated.”

Among the CCMR-Two trial patients was Hannah Threlfell, 43, from Abington in Oxfordshire, who was diagnosed with relapsing MS in 2019 after experiencing optic neuritis.

“Before I was diagnosed, I sat through a talk from MS specialist, Professor Alasdair Coles, about groundbreaking MS research. Even though I didn’t know I had it then, I remember thinking how incredible it was that so much had been achieved. And now I have MS, joining the trial was a no brainer,” said Hannah, a former teacher who has recently become a curate.

“I love helping and I know being on this trial will make a difference to someone else in the future – even small ripples have long-lasting effects. This research gives me even more reason to believe that in my lifetime everyone with MS will have treatments that work for them.”

CCMR-Two is funded by donations to the MS Society’s Stop MS Appeal, which aims to raise £100million by the end of 2025 to help find treatments to slow or stop the build-up of disability for everyone with MS.

And the approach taken could have implications elsewhere too.

Finding ways to protect the brain before irreversible damage sets in is key to any neurodegenerative conditions, from Alzheimer’s to Parkinson’s - diseases that cause impact millions and collectively cost the UK hundreds of billions of pounds.