Evaluating of the Effect of Fingolimod With Fish Oil on Relapsing-Remitting Multiple Sclerosis Patients

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2016-10-31

Brief Summary

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This study evaluates the effect of adding fish oil to Fingolimod on some serum cytokines in patients with Relapsing-Remitting Multiple Sclerosis.

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Detailed Description

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Multiple Sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory demyelinative lesions in central nervous system. Relapsing-Remitting MS is the most common form of the disease observed in 85% of patients. This form presents with acute or sub-acute onset of neurological symptoms and patients may fully or partially recover and relapses may occur from time to time.

Regarding MS pathogenesis, the findings suggest the role of environmental factors in triggering the innate immune system and activating T cells and the onset of a chronic inflammatory response against myelin antigens in the central nervous system in people who are genetically prone to the disease. Among immune cells, T helper 17 (Th17) plays an important role in autoimmune response and are shown to be involved in clinical course of Relapsing-Remitting MS. Th17 cell differentiation is controlled by several cytokines, including interleukin-6 (IL-6), interleukin-1b (IL-1b) and interleukin-10 (IL-10). Also, IL 6 have an inhibitory effect on Th17 cell differentiation through increased production of interferon-gamma (IFN-gamma) and IL 10.

Currently, immunomodulatory drugs are considered as the first line treatment in MS. Fingolimod is the first oral immunomodulatory medication used for Relapsing-Remitting MS. It is phosphorylated by crossing the blood-brain barrier and is converted to its active metabolite, Fingolimod-P. This metabolite acts as a Sphingosine-1-phosphate receptor (S1PR1) on oligodendrocytes, microglias, astrocytes, and neurons and inhibits the entry of lymphocytes into the central nervous system. Therefore, it reduces demyelination and may also lead to remyelination.

Nutrition is known as a possible environmental factor in pathogenesis of MS. Positive clinical and biological effects of dietary supplements containing polyunsaturated fatty acids omega -3 (PUFA) in the course of autoimmune diseases such as MS have been studied. High levels of PUFA is found in fish oil which is also known as an antioxidant, anti-inflammatory and immunomodulatory agent. Several studies have evaluated the effect of fish oil as a dietary supplement in the treatment of MS however, conflicting findings are reported.

In this study, the investigators aim to evaluate the effect of Fingolimod with Fish oil compared to Fingolimod with placebo on TNF-α, IL1b, IL6, and IFN-gamma in patients with Relapsing-Remitting Multiple sclerosis.

Conditions

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Multiple Sclerosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Fingolimod and Fish Oil

Fingolimod 0.5 mg capsule daily by mouth and Fish Oil 1 g capsule daily by mouth for one year.

Group Type EXPERIMENTAL

Fingolimod

Intervention Type DRUG

Produced by Osveh ® Pharm Company in Iran

Fish Oil

Intervention Type DIETARY_SUPPLEMENT

produced by Zahravi ® Pharm Company in Iran

Fingolimod and Placebo

Fingolimod 0.5 mg capsule daily by mouth and Placebo capsule daily by mouth for one year.

Group Type ACTIVE_COMPARATOR

Fingolimod

Intervention Type DRUG

Produced by Osveh ® Pharm Company in Iran

Placebo (for Fish Oil)

Intervention Type DRUG

placebo capsules to mimic Fish Oil 1 g capsules

Interventions

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Fingolimod

Produced by Osveh ® Pharm Company in Iran

Intervention Type DRUG

Fish Oil

produced by Zahravi ® Pharm Company in Iran

Intervention Type DIETARY_SUPPLEMENT

Placebo (for Fish Oil)

placebo capsules to mimic Fish Oil 1 g capsules

Intervention Type DRUG

Other Intervention Names

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Fingolid ® CODLIVE ® OMEGAMAX ®

Eligibility Criteria

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Inclusion Criteria

* Patients with relapsing-remitting multiple sclerosis according to McDonald's criteria (2010)
* Age between 18 and 45 years
* Expanded Disability Status Scale (EDSS) between 0-5
* History of at least one relapse during the last year
* Intolerance or serious complications when receiving interferons
* Not receiving interferons in the last two months
* Not having relapse in the last 30 days
* Negative pregnancy test
* History of varicella or varicella vaccination, or positive test for anti-varicella antibodies
* Not to take any medication or dietary complement without permission of the physician
* Filling informed consent

Exclusion Criteria

* Having chronic and infectious diseases
* History of cardiovascular diseases
* Taking corticosteroids in the last 30 days
* Taking chemotherapy agents such as Cyclophosphamide
* Patients who have taken fingolimod before
* Patients who experience relapse during the study

Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No