Polly: Why do they not give secondary progressive MSers statins even though they have been through phase 2 trials?
Professor Gavin Giovannoni, Neurologist: Well, the trial that showed that statins work in MS was the first positive trial and it was actually a very high dose of statin, simvastatin 80 milligrams. So the reason why we don’t do it, because there are risks of side effects and we’re not sure if the trial is a true positive or not. A large number of trials can be positive, we call them false positive, so that’s why we need a second, larger trial, and also to show that there is a good risk/benefit ratio. In other words, is it worth taking that dose of drug, achieving the benefits for the risks. That’s the real reason, we’re just not sure if it definitely works or not.
Polly: Okay, what’s your opinion? Are you hopeful that they will?
Professor Gavin Giovannoni: Yeah, I’m very hopeful. What’s interesting is the drug worked in the first year, which means that it may be working on a non-specific mechanism unrelated to MS. So people with secondary progressive multiple sclerosis tend to be older, they may have hypertension, high cholesterol, all those things, so this may be working on other mechanisms as well. So I think we need to work out how it’s working too.
Polly: Okay. What do you think about the fact that some GPs are prescribing them to people who are asking for them for this reason?
Professor Gavin Giovannoni: I don’t think there’s any danger because they’re usually probably using a much lower dose, and there’s also an argument for the whole country to be on statins after the age of 50. So at our university, Professor Nick Wald has developed the Polypill and part of that Polypill is simvastatin. And so at a population level statins may help with cardiovascular prevention, that’s preventing heart attacks and strokes. So there’s an argument for people to be on statins anyway over the age of 50, some good science behind it. So I don’t think it’ll be doing any damage, but it may be at a dose that doesn’t work, that’s the real question.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.