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Low-dose naltrexone (LDN)
One of the more contentious but promising new potential therapies for MS is low dose naltrexone. Naltrexone is a drug which reverses the effects of opiates like morphine or heroin. It is used in clinical practice in people trying to rid themselves of addiction to opiates. How it works in MS and other immune-mediated diseases, if it does, is the subject of some conjecture. But there seems to be overwhelming anecdotal evidence that it prevents relapses and also reduces disease progression.1 It has been suggested that it acts by reducing cell death in oligodendrocytes. There is considerable evidence available of its apparent benefit in individual cases published in a number of sites on the internet, but to date, there are no results from randomised controlled trials, although several are in progress. The drug does seem to be very promising though. An important aspect of this treatment is that it is relatively free of side-effects, unlike many of the other heavily promoted immune modulating therapies on the market. In addition, because it is a generic drug that cannot now be patented, it is very cheap, far cheaper than other currently available drugs. This may also explain why it hasn’t been studied much to date.
There are however a number of trials underway at present. A large RCT of 40 patients taking LDN for Crohn’s Disease is underway at Penn State University after a pilot study showed that two thirds of 17 patients taking the medication went into remission. 2 MS research is underway as well, with an Italian study enrolling 40 patients with primary progressive MS. The study will be reporting results shortly. A further RCT has finished enrolment at University of California, with 80 patients with relapsing-remitting MS randomised. Results should be available soon. The website www.lowdosenaltrexone.org gives periodic updates on progress.
- Agrawal YP. Low dose naltrexone therapy in multiple sclerosis. Med Hypotheses 2005; 64:721-724
- Smith JP, Stock H, Bingaman S, et al. Low-dose naltrexone therapy improves active Crohn's disease. Am J Gastroenterol 2007; 102:820-828
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