Table 1

Final recommendations of repurposed interventions for clinical testing in progressive MS

Final list of drugs for prioritisationMechanism of action
1. R-α-lipoic acid*Dietary supplement, approved in Germany for diabetic neuropathy; antioxidant, anti-inflammatory and neuroprotective.11 34 35
2. Metformin†Antihyperglycaemic agent used for type 2 diabetes mellitus; anti-inflammatory23 and promotes remyelination25 and neuroprotection.24
3. R-α-lipoic acid and metformin combinationMechanisms as above; complimentary mechanistic targets and neuroprotective in combination.27
4. Niacin‡Antihypercholesterolaemic drug; promotes oligodendrocyte proliferation,29 remyelination30and neuroprotection.28
5. ClemastineAntihistamine used for allergic rhinitis; off-target anti-muscarinic (M1) action, which promotes oligodendrocyte progenitor differentiation and remyelination.32 33
6. LamotrigineSodium channel antagonist widely used as an anticonvulsant; neuroprotective effects.36
7. OxcarbazepineSodium channel antagonist widely used as an anticonvulsant; neuroprotective effects.37
8. NimodipineCalcium channel antagonist used to treat vasospasm in subarachnoid haemorrhage; promotes remyelination, neuroprotection38 and restores CNS perfusion and oxygenation.39
9. FlunarizineMigraine prophylactic; neuroprotective effects.40

  • The top four were determined to be the most promising for clinical evaluation.

  • *1200 mg/day.

  • †1 g twice daily, starting at 500 mg twice daily.

  • ‡750 mg twice daily of slow release formulation of Niaspan.

  • CNS, central nervous system.