Chauhan Prerna, Kakkar Ashish Kumar, Singh Harmanjit, Gautam C S
Department of Pharmacology, All India Institute of Medical Sciences , New Delhi, India.
Department of Pharmacology, Postgraduate Institute of Medical Education and Research , Chandigarh, India.
Expert Rev Neurother. 2021 Jan;21(1):35-43. doi: 10.1080/14737175.2020.1838276. Epub 2020 Nov 5.
Multiple sclerosis (MS) is a chronic demyelinating inflammatory disorder with variable clinical and pathologic characteristics reflecting multiple underlying pathophysiologic mechanisms. Repositioning of existing drugs for the new indications offers several advantages including significant reduction in the cost and time of drug development and exemption from early phase clinical trials. Minocycline has been reported to exhibit immunomodulation in several pre-clinical and clinical studies through suppression of migratory inflammatory cells, modulation of peripheral immune response, and inhibition of microglial activation within the CNS.
Here, the authors review the repositioning potential of minocycline for the treatment of MS along with appraisal of the evidence obtained from preclinical and clinical research. The authors also discuss the advantages and potential safety concerns related to the use of minocycline for the management of MS.
Minocycline offers several distinct advantages in terms of well-known safety profile, lower cost of therapy, widespread availability, and being available as an oral formulation. The authors call upon the public and private funders to facilitate well designed and adequately powered randomized clinical trials that can provide conclusive evidence regarding the safety and efficacy of minocycline in patients with MS.
多发性硬化症（MS）是一种慢性脱髓鞘炎症性疾病，具有多种临床和病理特征，反映了多种潜在的病理生理机制。将现有药物重新定位用于新适应症具有诸多优势，包括显著降低药物开发成本和时间，并免于进行早期临床试验。在多项临床前和临床研究中，据报道米诺环素通过抑制迁移性炎症细胞、调节外周免疫反应以及抑制中枢神经系统内的小胶质细胞活化来发挥免疫调节作用。
在此，作者回顾了米诺环素治疗MS的重新定位潜力，并对临床前和临床研究获得的证据进行了评估。作者还讨论了使用米诺环素治疗MS的优势和潜在安全问题。
米诺环素在安全性良好、治疗成本较低、广泛可得以及有口服制剂等方面具有几个明显优势。作者呼吁公共和私人资助者推动设计良好且有足够效力的随机临床试验，以提供关于米诺环素对MS患者安全性和有效性的确凿证据。
