Clemastine 500micrograms/5ml oral solution sugar free

BACKGROUND: In multiple sclerosis (MS), progressive disability occurs following degeneration of demyelinated axons. A tractable approach to delay, prevent or reverse disability progression is through enhancement of endogenous remyelination. Clinical trials have deployed drugs, such as clemastine, to target the rate-limiting step in this process: differentiation of oligodendrocyte progenitor cells (OPCs). Preclinical research has shown that metformin can reverse an age-associated deficit in the responsiveness of OPCs to pro-differentiation factors. The purpose of the Cambridge Centre for Myelin Repair trial Two (CCMR Two) is to evaluate the efficacy of the combination of metformin and clemastine to promote remyelination in people with MS. METHODS: Participants with relapsing-remitting MS (RRMS) will be randomised 1:1 to the combination of metformin and clemastine or matched placebos and followed for 24 weeks of treatment. All participants must be stable on a disease-modifying therapy and have evidence of chronic stable optic neuropathy in at least one eye (defined by P100 latency of the visual evoked potential (VEP) ≥ 118 ms, and the absence of a history of acute optic neuritis in the preceding 2 years). The primary outcome measure will be the change in the P100 latency of the full-field VEP between baseline and week 26. It is planned to recruit a total of 70 participants. This will have 80% power to detect a reduction of 3 ms in VEP P100 latency between the two treatment groups. Secondary outcome measures will examine the change in multifocal VEP and the change in lesional magnetisation transfer ratio (MTR) for lesions stratified by location and tissue-specific cohort baseline lesional MTR values. DISCUSSION: We set out the trial design, the rationale for participant and outcome measure selection, and the pre-specified analyses. With this trial, we expect to be able to detect the structural and functional consequences of remyelination within a sample size feasible for our single-centre trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT05131828, prior to participant enrolment.

Abstract licence: CC BY

White matter in the central nervous system comprises bundled nerve fibers myelinated by oligodendrocytes. White matter injury, characterized by the loss of oligodendrocytes and myelin, is common after ischemic brain injury, inflammatory demyelinating diseases including multiple sclerosis, and traumatic damage such as spinal cord injury. Currently, no therapies have been confirmed to promote remyelination in these diseases. Over the past decade, various reports have suggested that the anti-muscarinic drug clemastine can stimulate remyelination by oligodendrocytes. Consequently, the repurposing of clemastine as a potential treatment for a variety of neurological disorders has gained significant attention. The therapeutic effects of clemastine have been demonstrated in various animal models, and its mechanisms of action in various neurological disorders are currently being investigated. In this review, we summarize reports relating to clemastine administration for white matter injury and neurological disease and discuss the therapeutic potential of remyelination promotion.

Abstract licence: CC BY