COMMENTARY

A Transdermal Myeloid Peptide Patch to Treat MS

Laurie L. Barclay, MD

Disclosures

October 28, 2013

Transdermal Application of Myelin Peptides in Multiple Sclerosis Treatment

Walczak A, Siger M, Ciach A, Szczepanik M, Selmaj K
JAMA Neurol. 2013;70:1105-1109

Study Summary

Although antigen-specific autoimmunity is thought to play a critical role in the pathogenesis of multiple sclerosis, all currently available therapies reduce global immune function without targeting the specific antigens involved. The goal of this 1-year, double-blind, placebo-controlled cohort study was to examine the efficacy and safety of transdermally applied myelin peptides as antigen-specific therapy in multiple sclerosis.

At a referral center, 30 outpatients 18-55 years of age with relapsing-remitting multiple sclerosis were randomly assigned to receive a skin patch containing a mixture of 1 mg each of 3 myelin peptides, MBP85-99, MOG35-55, and PLP139-155 (n = 16); a mixture of 10 mg each of these 3 myelin peptides (n = 4); or placebo (n = 10). The cumulative number of active gadolinium-enhanced (Gd+) lesions during the 12-month study (the primary endpoint) was 66.5% lower in patients receiving the myelin peptide skin patch than in those receiving placebo (P=.02).

Patients receiving the myelin peptide skin patch also fared significantly better than those receiving placebo in terms of annual relapse rate (0.43 vs 1.4; P=.007) and all other examined secondary MRI outcomes (mean volume of Gd+ lesions, cumulative number of new T2 lesions, and T2 lesion and T1 lesion volume change from baseline to the end of the study).

Tolerability of the myelin peptide skin patch was good, even in patients given a 10-mg dose, and no serious adverse events were reported. The most common adverse effect was local reaction in the area of the skin patch, with mild redness and itching in 20% of patients receiving the myelin peptide skin patch.

Viewpoint

Limitations of this study include a small sample size and an insufficient number of patients in the 10-mg group to draw dose/response conclusions. Nonetheless, the findings suggest that treatment with a myelin peptide skin patch significantly reduced both MRI and clinical measures of disease activity in patients with relapsing-remitting multiple sclerosis. This antigen-specific therapy appeared to have beneficial effects on blood/brain barrier opening, and on generation of both new inflammatory lesions and established MRI lesions.

Furthermore, this treatment appeared to be safe and well tolerated. If the findings are confirmed in a larger study, the myelin peptide skin patch may be a promising antigen-specific therapy for patients with relapsing-remitting multiple sclerosis.

Abstract

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