- Among patients with relapsing multiple sclerosis (MS), hookworm treatment was safe but did not affect lesion findings on MRI.
Why this matters
- Approaches that modify the innate immune response are attractive.
- Editorial: Despite safety, efficacy "appears modest, making it unlikely to be a sufficient stand-alone treatment for MS."
- Also notes concerns about helminths as add-on, "given the potential increase in infection rates when used with concomitant immunomodulating medications.”
- During months 3 to 9 postinfection, no significant difference was detected between hookworm and placebo groups in total number of new T2 lesions, newly enhancing T1-weighted lesions, or T2 enlarging lesions:
- Median: 0 vs 1.5.
- Mean: 4.1 vs 3.8.
- Hookworm group:
- Somewhat less likely to have any MRI activity (OR, 0.33; 95% CI, 0.11-1.02).
- Higher percentage of CD4+CD25highCD127neg T cells in peripheral blood (4.4% vs 3.9%; P=.01).
- Lower relapse rate per patient (14.3% vs 30.6%).
- No withdrawals for adverse effects.
- Only differing adverse event was more application-site skin discomfort in hookworm group (82.86% vs 27.78%).
- UK single-center phase 2 randomized controlled trial among 71 adults with relapsing MS not receiving disease-modifying treatment (WIRMS trial).
- Randomization: single transcutaneous administration of live, infective hookworms (25 Necator americanus larvae) vs placebo.
- Main outcome: new/enlarging/enhancing MRI lesions.
- Funding: MS Society of Great Britain and Northern Ireland; Bayer-Schering; others.
- Choice of main outcome measure.
- Fairly short treatment duration.
- Unclear generalizability to progressive MS.