From the Guidelines
Naltrexone is not a standard treatment for multiple sclerosis (MS) and its use is not supported by recent high-quality evidence. MS is an autoimmune disease affecting the central nervous system that is usually treated with disease-modifying therapies like interferon beta, glatiramer acetate, fingolimod, or ocrelizumab 1. Naltrexone is primarily approved for treating opioid and alcohol dependence by blocking opioid receptors. However, some physicians prescribe low-dose naltrexone (LDN, typically 1.5-4.5 mg daily) off-label for MS patients based on limited research suggesting it might have anti-inflammatory effects and potentially help with certain MS symptoms like fatigue or pain.
The recent studies on autologous haematopoietic stem cell transplantation (AHSCT) for treatment of multiple sclerosis and neuromyelitis optica spectrum disorder provide guidance on the use of AHSCT in MS, but do not mention naltrexone as a treatment option 1. The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Society for Blood and Marrow Transplantation (EBMT) recommend AHSCT for selected indications in relapsing–remitting MS, but do not recommend naltrexone.
Key points to consider:
- Naltrexone is not a replacement for established MS treatments
- Patients interested in LDN should discuss it with their neurologist and not discontinue their prescribed MS medications
- There is insufficient scientific evidence from large clinical trials to support the routine use of naltrexone for MS
- Recent high-quality studies focus on AHSCT and other disease-modifying therapies, but do not support the use of naltrexone for MS 1.
From the Research
Naltrexone Use in Multiple Sclerosis
- Naltrexone, specifically low-dose naltrexone (LDN), has been explored as a potential treatment for multiple sclerosis (MS) due to its possible effects on the immune system and its potential to reduce symptoms associated with the disease 2, 3, 4, 5, 6.
- Studies have investigated the use of LDN in MS patients, with some indicating that it may have beneficial effects, such as reducing relapses and improving quality of life 3, 4, 6.
- A quasi-experimental study found that the initiation of LDN was not followed by reductions in other medications used to treat symptoms associated with MS, suggesting that LDN may not have a significant impact on disease progression 2.
- Randomized controlled trials have reported mixed results, with some finding significant improvements in mental health quality of life measures 4 and others finding no meaningful differences between LDN and placebo groups 5.
- A pilot trial in primary progressive multiple sclerosis found that LDN was safe and well-tolerated, with a significant reduction in spasticity measured at the end of the trial 6.
Key Findings
- LDN may be associated with improved mental health quality of life in MS patients 4.
- LDN has been found to be safe and well-tolerated in MS patients, with minimal adverse events reported 2, 4, 5, 6.
- The efficacy of LDN in reducing disease progression and improving overall quality of life in MS patients is still uncertain and requires further investigation 2, 3, 4, 5, 6.