Tropical Myeloneuropathies Medication

Updated: Jan 13, 2015
  • Author: Friedhelm Sandbrink, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Medication

Medication Summary

HAM/TSP

A multicenter, randomized, double-blind study in 48 patients indicated that treatment with subcutaneous interferon alfa (Roferon) 3 million U (MU) twice a week was effective in more than 66.7%. [12] In another study, 32 patients were treated with interferon alfa; 20 patients showed a fair-to-excellent response in motor function. The effect was sustained, however, for only 1-3 months after the last injection. [10]

An open-label study showed that pentoxifylline 300 mg PO once a day induced clinical improvement in 14 of 15 patients. The authors postulated that the effect probably was due to TNF-alpha suppression. [13] In a recent open-label trial, 12 patients with HAM/TSP were treated with doses of interferon beta-1a of up to 60 µg twice weekly. During the trial, the therapy reduced the HTLV-1 tax messenger RNA load, but the HTLV-1 proviral DNA load remained unchanged. Some measures of motor function were improved, and no significant clinical progression occurred during therapy. [14]

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Interferons

Class Summary

These agents are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions.

Interferon beta-1a (Avonex, Rebif)

For treatment of relapsing remitting MS. Avonex has also gained approval for treating patients with a first MS attack if brain MRI shows abnormalities characteristic of MS. Believed to act via ability to counteract cell surface expression of proinflammatory or pro-adhesion molecules on immune cells, among other effects. More studies needed to fully understand mechanisms of action. Only differs from interferon beta-1b in that it has amino acid sequence identical to that of natural compound and is glycosylated. Presence of glycosylation may lead to structural stability and presumably to higher biological potency.

Interferons act through common receptor that activates Jak/Stat pathway of signal transduction molecules, which, in turn, lead to activation of interferon-responsive genes. Interferon beta may decrease expression of B7-1 (a proinflammatory molecule) on surface of immune cells and increase levels of TGF-beta (anti-inflammatory) in circulation of MS patients. Interferon beta-1a is most convenient ABC drug to administer due to weekly schedule.

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Blood viscosity reducer agents

Class Summary

These agents decrease the viscosity of blood.

Pentoxifylline (Trental)

May alter rheology of red blood cells, which, in turn, reduces blood viscosity

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