Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial

@article{Voskuhl2016EstriolCW,
  title={Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial},
  author={Rhonda R. Voskuhl and He-jing Wang and T. C. Jackson Wu and Nancy L. Sicotte and Kunio Nakamura and Florian Kurth and Noriko Itoh and Jenny Bardens and Jacqueline Bernard and John R. Corboy and Anne Haney Cross and S. Dhib-jalbut and Corey C. Ford and Elliot M. Frohman and Barbara S. Giesser and Dina A. Jacobs and Lloyd H. Kasper and Sharon G. Lynch and Gareth Parry and Michael K. Racke and Anthony T. Reder and John W. Rose and Dean M. Wingerchuk and Allan MacKenzie-Graham and Douglas L. Arnold and Chi-Hong Tseng and Robert M. Elashoff},
  journal={The Lancet Neurology},
  year={2016},
  volume={15},
  pages={35-46}
}
BACKGROUND Relapses of multiple sclerosis decrease during pregnancy, when the hormone estriol is increased. Estriol treatment is anti-inflammatory and neuroprotective in preclinical studies. In a small single-arm study of people with multiple sclerosis estriol reduced gadolinium-enhancing lesions and was favourably immunomodulatory. We assessed whether estriol treatment reduces multiple sclerosis relapses in women. METHODS We did a randomised, double-blind, placebo-controlled phase 2 trial at… 
Why use sex hormones in relapsing-remitting multiple sclerosis? – Authors' reply
TLDR
This phase 2 trial of the use of estriol in combination with glatiramer acetate in women with relapsing-remitting multiple sclerosis was positive for this clinical outcome as well as two of the three secondary outcomes—probability of fi rst confi rmed relapse and annualised relapse event rate.
Oral contraceptives and MS disease activity in a contemporary real-world cohort
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Comparing annualized relapse rate from baseline DMT start across the three OC use categories using a negative binomial regression model provides reassurance for women newly diagnosed that OC use, past or current, does not appear to be associated with greater risk of relapses.
Determining the effectiveness of early intensive versus escalation approaches for the treatment of relapsing-remitting multiple sclerosis: The DELIVER-MS study protocol.
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Natural menopause seems to be a turning point to a more progressive phase of MS, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease.
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TLDR
Transvaginal estriol potentially offers a suitable physiologic delivery and cost-effective alternative to currently available estrogen regimens in selected patients and may offer a wide range of health benefits, including improved control of menopausal symptoms and better urogenital health.
Pregnancy: Effect on Multiple Sclerosis, Treatment Considerations, and Breastfeeding
TLDR
Clinical aspects of pregnancy, including the effects of pregnancy on MS disease activity, as well as the medical management of MS during pregnancy and postpartum are focused on.
Hormone replacement in menopausal women with multiple sclerosis
TLDR
A retrospective analysis of data acquired from the Nurse's Healthy Study including 248 MS cases found that there was an association between better PF10 scores and estrogen use (mainly Premarin use), suggesting that hormone treatment may uniquely benefit physical functioning in women with MS.
Reproductive Issues in MS
TLDR
The use of immunosuppressive or immunomodulatory agents in pregnancy is not routinely advisable but could be considered under special circumstances, although clear prospective data of sufficient length and quality are limited.
Testosterone and estrogen in multiple sclerosis: from pathophysiology to therapeutics
TLDR
Estriol therapy in two phase 2 trials showed a decrease in clinical disease activity and inflammatory parameters in MRI, however, evidence of a therapeutic effect of testosterone is scarce and these hormones should be considered as an adjunctive therapy.
Enduring Clinical Value of Copaxone® (Glatiramer Acetate) in Multiple Sclerosis after 20 Years of Use
  • D. Wynn
  • Medicine
    Multiple sclerosis international
  • 2019
TLDR
An overview of the important developments in the MS field during the 20 years since GA was approved is provided and clinical data for GA in MS is reviewed, with the aim of understanding the continued and widespread use of GA.
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