Citicoline: A Candidate for Adjunct Treatment of Multiple Sclerosis

Grieb, Paweł; Świątkiewicz, Maciej; Kamińska, Agnieszka; Jünemann, Anselm; Ręjdak, Robert; Rejdak, Konrad

doi:10.3390/ph14040326

Cited by 9 publications

(9 citation statements)

References 66 publications

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“…Citicoline, a neuroprotective drug, has been shown to improve and speed up remyelination in MS patients. It was found to be significantly effective in two complementary MS rodent models [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

Tjoanda,

Kartika,

Ginting

et al. 2024

Case Rep Ophthalmol

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Introduction: Multiple sclerosis (MS) is a demyelinating condition of the central nervous system (CNS) that primarily affects young adults. Very late-onset multiple sclerosis (VLOMS) is an uncommon form of MS, accounting for only 0.5 percent of all MS patients. Eye movement impairments such as internuclear ophthalmoplegia are common in MS, while horizontal gaze palsy is an uncommon occurrence. Case Presentation: We report a case of a patient diagnosed with VLOMS who presented with left horizontal gaze palsy and ipsilateral facial nerve palsy. Brain magnetic resonance imaging showed Dawson’s fingers in the left and right periventricular white matter; multiple small, round, hyperintense lesions in the left and right cortex and juxtacortical cerebellar hemisphere; and small hyperintense lesion in the left paramedian pontine reticular formation, suggesting the diagnosis of MS. Oral corticosteroids led to complete resolution of ocular movement and ipsilateral facial nerve palsy. Conclusion: We propose that neuroimaging should be performed in ophthalmoplegia with a pattern representing CNS lesion and oral corticosteroids may be an effective alternative to high-cost intravenous corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

Tjoanda,

Kartika,

Ginting

et al. 2024

Case Rep Ophthalmol

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“…While our study analyzed only the neuroprotective efficacy of citicoline among patients following TBI, clinical trials and real-life studies have confirmed its excellent safety profile [ 5 , 14 , 17 ]. The neuroprotective effects of citicoline should not be limited to patients with TBI but instead could also be extended to patients with other neurological diseases [ 14 ], as some studies have suggested, including COVID-19-related cognitive complications, multiple sclerosis, and dementia [ 67 , 68 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis

Secades

Trimmel

Salazar³

et al. 2023

Life

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Background: Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI. Methods: A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients— that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up. Results: In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05–1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed. Conclusions: This meta-analysis indicates some beneficial effects of citicoline’s increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included. Registration: PROSPERO CRD42021238998

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“…The bioavailability of CDP-choline administrated upon oral and intravenous routes is similar [75]. After injection, CDP-choline is rapidly metabolized to its cholinergic and pyrimidinergic catabolites, being probably even safer and a more "procognitive" form of choline supplement [76][77][78][79][80][81]. Nevertheless, there are still a lot of open questions regarding the place and particular mechanisms of CDP-choline catabolism and its precise mode of action as well its involvement in some kinases activation and trimethylamine N-oxide (TMAO) formation [58,76].…”

Section: Discussionmentioning

confidence: 99%

Regenerative Effects of CDP-Choline: A Dose-Dependent Study in the Toxic Cuprizone Model of De- and Remyelination

et al. 2021

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Inflammatory attacks and demyelination in the central nervous system (CNS) are the key factors responsible for the damage of neurons in multiple sclerosis (MS). Remyelination is the natural regenerating process after demyelination that also provides neuroprotection but is often incomplete or fails in MS. Currently available therapeutics are affecting the immune system, but there is no substance that might enhance remyelination. Cytidine-S-diphosphate choline (CDP-choline), a precursor of the biomembrane component phospholipid phosphatidylcholine was shown to improve remyelination in two animal models of demyelination. However, the doses used in previous animal studies were high (500 mg/kg), and it is not clear if lower doses, which could be applied in human trials, might exert the same beneficial effect on remyelination. The aim of this study was to confirm previous results and to determine the potential regenerative effects of lower doses of CDP-choline (100 and 50 mg/kg). The effects of CDP-choline were investigated in the toxic cuprizone-induced mouse model of de- and remyelination. We found that even low doses of CDP-choline effectively enhanced early remyelination. The beneficial effects on myelin regeneration were accompanied by higher numbers of oligodendrocytes. In conclusion, CDP-choline could become a promising regenerative substance for patients with multiple sclerosis and should be tested in a clinical trial.

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Citicoline: A Candidate for Adjunct Treatment of Multiple Sclerosis

Cited by 9 publications

References 66 publications

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report

Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis

Regenerative Effects of CDP-Choline: A Dose-Dependent Study in the Toxic Cuprizone Model of De- and Remyelination

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