For the past several years there has been a bit of a cult following with a drug called LDN (low-dose naltrexone) . While writing at Suite101’s health site, I encountered several readers with MS who promoted the drug in comments sections, as well as a fellow health writer (with hyperthyroidism) who valued and wrote about its merits. There wasn’t much known about the drug then except that it wasn’t FDA-approved for multiple sclerosis patients and it wasn’t clear whether the drug could actually slow MS disease progress. Just recently I read an article from the National Multiple Sclerosis Society’s Momentum magazine with a current view about LDN. Here is what Dr. Allen C. Bowling, a neurologist and professor at the University of Colorado-Denver and Health Sciences Center, reports:
What is Low-Dose Naltrexone?
Dr. Bowling addresses the fact that LDN is getting a great deal of coverage on the internet, including various websites that are run by low-dose naltrexone organizations. Although LDN is reported to help patients with multiple sclerosis, it is considered a CAM or complementary and alternative medicine because it has not been extensively tested for effectiveness in patients with MS. Currently naltrexone is approved for opiate and alcohol addiction, with patients being treated with doses of roughly 50 milligrams/day. Patients who take LDN for MS use about 1.5 to 4.5 milligrams/daily, hence the name.
Naltrexone, which may increase endorphin productivity and increase the body’s sensitivity to it, could very well reduce pain and inflammation, as well as stabilize overall mood. It also may decrease the formation of free radicals (considered harmful) and thus protect nerve cells from injury.
LDN Studies, to Date
Not a great deal of low-dose naltrexone research has been done. Here are some recent studies and their results:
- Two small, preliminary studies of LDN for EAE (experimental autoimmune encephalomyelitis which is an animal model of MS) found that LDN decreased nervous system inflammation, immune cell activation, and possible disease severity. These studies were presented at the annual meeting of the European Congress for Treatment and Research in MS (2008.)
- A small clinical trial on humans with MS (reported at the same meeting this past year) was conducted at the University of California-San Francisco. 80 people were treated for 8 weeks with either LDN or a placebo. The LDN showed no effect on physical functioning, but it showed an improvement in some patients’ mental health and pain symptoms.
- 40 primary-progressive MS patients in Italy were studied in 2008. LDN was administered for 6 months, although there was no placebo-treated control group for comparison. Patients noted an improvement in spasticity, but no effects on depression, fatigue, or overall quality of life. Some patients reported a worsening of pain. Only one patient showed a neurological worsening during the treatment.
What Does this Mean to MS Patients?
Dr. Bowling stresses that the preliminary studies still don’t show enough evidence that LDN effectively reduces multiple sclerosis inflammation/nerve attacks in humans and thereby slows MS’s progression in patients. The studies are a good start in the discovery of what low-dose naltrexone is capable of, although the studies on EAE were done on animals and not true MS patients, and the other studies were brief and the results were conflicting.
Questions Dr. Bowling—as well as other neurologists– still have:
- Does LDN truly and consistently decrease the severity of MS symptoms?
- Does LDN slow the progression of relapsing and/or progressive MS?
- Is LDN safe to use on a long-term basis?
- Does LDN interact with conventional MS medications?
In the meantime, low-dose naltrexone continues to be considered a complimentary and alternative medicine and is being further studied to determine its ability to slow disease progression (like other disease-modifying meds), its long-term safety, and its ability to effectively treat symptoms. At this point, many MS patients have been able to acquire it for “non-MS” use.
For further reference:
Bowling, Allen C, MD. “Low-Dose Naltrexone (LDN): The ‘411’ on LDN.” Momentum, the Magazine of the National Multiple Sclerosis Society. Spring 2009, pp 44 – 46.