MS and Acne

Jun 8, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Eric - walk the dog." "I did." "Farther than the end of the driveway." "Uuuuug!" "Why were you untying your shoe laces in the middle of the lawn?" "So I didn't have to do it inside." I guess I can't argue with that logic. So we'll let that one slide. I'm looking out the window, trying to finish my article. Doris is in Winnipeg with Emily on a school trip, so Eric only has one distracted parent giving him orders this morning. He is already winning. His opening salvo was to suddenly make friends appear while I was in the shower. I came out of my room to find them playing video games. Then the perpetual "Walk the dog" argument. Then the perpetual "Have you made a lunch?" argument. All while I just need a few quiet minutes to finish this freaking article. Single parenting sucks, and I'm pretty sure Eric knows he has me on the ropes. Couldn't this just be more simple?

Multiple Sclerosis complicates many people's lives in the Parkland. Canada has one of the highest rates of MS in the World. The Manitoba and Saskatchewan area have one of the highest rates of MS in Canada. We have some powerful immune suppressing drugs to treat MS. Since we believe it is our own immune system that attacks the myelin sheath around the nerve fibers in MS, if we suppress the immune system that should reduce symptoms. And these powerful immune suppressors do work for many people with the disease. However, many of these immune suppressors are injectable and very expensive. Wouldn't it be nice if there were cheaper, simpler, oral options? Researchers in Calgary might have that simple option for us. And they just published their results in the June 1, 2017 New England Journal of Medicine.

Let's back up. What is MS or multiple sclerosis? It is an unpredictable and often debilitating disease of the brain and spinal cord. Some of the long nerves in the brain and spinal cord have a covering called myelin. Remember when all phones were connected to the wall with a cord? Myelin works a like the plastic covering around the telephone cord. Without the insulating plastic cover, some of the signal that goes down the telephone wire would leak out. The voice on the phone would sound delayed, weakened, garbled or possibly not there at all. In MS, the immune system mistakenly attacks the insulating myelin sheath around some of the nerve fibers. That makes the signals from the brain to the body or body back to the brain get weaker, delayed, garbled or go missing altogether.

Multiple Sclerosis is the most common neurological disorder in young adults. Every day, three more people in Canada are diagnosed with MS. It is estimated that more than 100,000 Canadians have Multiple Sclerosis. Around 3500 people in Manitoba have MS. Women are more than three times as likely to develop MS as men. MS can cause loss of balance, impaired speech, extreme fatigue, double vision and paralysis.

Since MS affects some myelin covers some of the time, this leads to one of the most fascinating and frustrating facets of the disease. The symptoms of MS can change and are unpredictable. The most common form of MS, relapsing and remitting MS, has well defined attacks followed by complete or partial recovery. It can go away and come back. And it can affect vision, hearing, memory, balance and mobility. And this is not just that the disease affects different people in different ways! The same person can have different symptoms each attack. You can imagine how frustrating it would be to both worker and employer if a worker came to work one week in a wheel chair and then the next month she could walk. Then six months later she could still walk, but says she can't read her computer screen without magnification. And then she is fine. And then a year later she calls in sick for 3 weeks because she is too fatigued to leave the house. Unfortunately, since people with MS often don't look sick and they have symptoms that come and go, some confused employers treat employees with MS unfairly.

A Canadian clinical trial led by researchers at the University of Calgary's Hotchkiss Brain institute found that minocycline can slow the progression of relapsing-remitting MS in patients who have just experienced their first symptoms. Luanne Metz et al. enrolled 142 patients across 12 Canadian MS Clinics including the one in Winnipeg. These participants had experienced their first MS symptoms during the previous 6 months. Half the participants got minocycline 100mg twice a day and half got placebo. Minocycline is a common and inexpensive antibiotic that is often used to treat acne among other things. The research team wanted to know how many of these people with only one attack of MS, which is sometimes called clinically isolated syndrome, went on to develop full blown MS.

At 6 months 61% of the placebo group had developed full blown MS, while only 33.4% of the minocycline group had. By 24 months pretty much as many people in the minocycline group had full blown MS as in the placebo group. Now that might sound disappointing, but it really is in line with what our current MS immune suppressing drugs can do. They delay the onset of more severe symptoms. Minocycline seems to delay the onset of more severe symptoms by up to 2 years. It is inexpensive, a pill not an injection and something neurologists can start using today! Since minocycline is already approved for use in Canada, the MS doctors don't have to wait for any other Health Canada approval.

Minocycline will be another nice tool in the MS treatment tool kit. It might not be the end all and be all for everyone all the time, but it is inexpensive, easy to use and frankly simple. I think Eric and his friends have finally left the house. I don't think they'll be late for school. Now I simply need Sheldon to not bark at me while I think of a funny anecdote for this MS article. The simple answer is I've got nothing. Oh well. Maybe I can be funny next week. Maybe instead of just inviting his friends in to play video games while I'm in shower, Eric will decide to have a marshmallow roast in the living room. I can only hope.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

MS Society of Canada www.mssociety.ca

Minocycline and MS - https://mssociety.ca/resources/news/article/common-acne-medication-offers-new-treatment-for-multiple-sclerosis

NEJM article on Minocycline and MS Trial - http://www.nejm.org/doi/full/10.1056/NEJMoa1608889?query=featured_home&

 


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