Low dose naltrexone in multiple sclerosis: Effects on medication use. A quasi-experimental study

Abstract

Low dose naltrexone (LDN) has become a popular off-label therapy for multiple sclerosis (MS). A few small, randomized studies indicate that LDN may have beneficial effects in MS and other autoimmune diseases. If proven efficacious, it would be a cheap and safe alternative to the expensive treatments currently recommended for MS. We investigated whether a sudden increase in LDN use in Norway in 2013 was followed by changes in dispensing of other medications used to treat MS. We performed a quasi-experimental before–and–after study based on population data from the Norwegian Prescription Database (NorPD). We included all patients that collected at least one LDN prescription in 2013, and had collected at least two medications with a reimbursement code for MS, or collected a medication with MS as the only indication in 2009 or 2010. Outcomes were differences in cumulative dispensed doses and incidence of users of disease modifying MS therapies, and medications used to treat MS symptoms two years before and two years after dispensing the initial LDN prescription. The eligible 341 patients collected 20 921 prescriptions in the observation period. Apart from changes in line with general trends in MS therapy in Norway, there was no difference in neither dispensed cumulative doses or number of prevalent users of MS specific medication. Initiation of LDN was not followed by reductions of other medications used to treat symptoms associated with MS.

No change in the consumption of thyroid hormones after starting low dose naltrexone (LDN): a quasi-experimental before-after study

“…The negative findings in this study fit into the mixed results of clinical and pharmacoepidemiological studies on LDN in autoimmune disease [1,8,9].…”

“…We defined the first prescription in 2013 as index data, and stratified patients in three groups according to LDN exposure in the 2 years after index date: LDN × 1 (controls, collected LDN once), LDN × 2-3 (collected LDN twice or thrice) and LDN × 4+ (persistent users, collected LDN > 3 times). We have previously used the same stratification in other studies [7][8][9].…”

The Effect of Low-Dose Naltrexone on Medication in Inflammatory Bowel Disease: A Quasi Experimental Before-and-After Prescription Database Study

“…In a study with a similar design, we found no association between the initiation of LDN and prescription patterns of relevant medication in multiple sclerosis. 14 …”

Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization

“…Commonality in all studies was the drug being well tolerated and compatible with standard MS therapy (Table 2). Interestingly, the large scale pharmacoepidemiological Norwegian study with a complete drug dispensing database has not found any difference regarding standard therapy utilization among MS-affected patients who were provided with LDN over a prospective two-year period [50].…”