Systematic approach to selecting licensed drugs for repurposing in the treatment of progressive multiple sclerosis
Nick Cunniffe, Khue Anh Vuong, Debbie Ainslie, David Baker, Judy Beveridge, Sorrel Bickley, Patrick Camilleri, Matthew Craner, Denise Fitzgerald, Alerie Guzman de la Fuente, Gavin Giovannoni, Emma Gray, Lorraine Hazlehurst, Raj Kapoor, Ranjit Kaur, David J. Kozlowski, Brooke Lumicisi, Don Mahad, Björn Neumann, Alan M. Palmer, Luca Peruzzotti‐Jametti, Stefano Pluchino, Jennifer Robertson, Rothaul Alan, L. Shellard, Kenneth J. Smith, Alastair Wilkins, Anna Williams, Alasdair Coles
Abstract
OBJECTIVE: To establish a rigorous, expert-led, evidence-based approach to the evaluation of licensed drugs for repurposing and testing in clinical trials of people with progressive multiple sclerosis (MS). METHODS: We long-listed licensed drugs with evidence of human safety, blood-brain barrier penetrance and demonstrable efficacy in at least one animal model, or mechanistic target, agreed by a panel of experts and people with MS to be relevant to the pathogenesis of progression. We systematically reviewed the preclinical and clinical literature for each compound, condensed this into a database of summary documents and short-listed drugs by scoring each one of them. Drugs were evaluated for immediate use in a clinical trial, and our selection was scrutinised by a final independent expert review. RESULTS: From a short list of 55 treatments, we recommended four treatments for immediate testing in progressive MS: R-α-lipoic acid, metformin, the combination treatment of R-α-lipoic acid and metformin, and niacin. We also prioritised clemastine, lamotrigine, oxcarbazepine, nimodipine and flunarizine. CONCLUSIONS: We report a standardised approach for the identification of candidate drugs for repurposing in the treatment of progressive MS.