Creatine and Minocycline as Treatment Against ALS

Scientists report today in the current issue of Annals of Neurology that mice treated with a combination of creatine and minocycline show a greater increase in survival than either drug alone. Robert Friedlander, a professor of neurosurgery at Brigham and Women's Hospital and Harvard Medical School in Boston and his group treated mice presymptomatically with either minocycline or creatine alone and compared them to mice treated with creatine and minocycline. There was 12% increase in survival in the group of mice treated with creatine and a 13% increase in survival in the group treated with minocycline. In mice treated with the combination of the two compounds survival was increased by 25%.

It should be noted that many of the compounds tested in the mouse models of ALS including this study are administered prior to onset of symptoms. This is not the case in the clinical setting where patients are already showing symptoms of the disease at the time they take the drugs and may account for the modest effect of these drugs in the clinic. This further supports the potential of combining drugs acting on different disease mechanisms to treat patients with ALS.

Stephen Scelsa, MD, Director of the Neuromuscular Division and ALSA Certified Center, Beth Israel Medical Center and Associate Professor of Clinical Neurology, Albert Einstein Medical School, New York, New York, comments, "This is exciting news since many leaders in ALS research believe that progress will be made in slowing disease progression by combining less effective therapies with different mechanisms of action. It will be important first to show, through clinical trials, that each of these drugs has at least some marginal benefit in patients with ALS, before trying combination therapy, since only one drug in a combination may be effective. Fortunately, both creatine and minocycline have few serious side effects. I hope that the findings in clinical trials of these drugs in humans will mimic the findings in mice. We will only determine this by carefully planned, placebo-controlled trials."

"This is an important finding from animal research that may have a potential direct benefit for people with ALS," notes Mary Lyon, RN, MN, ALSA's Vice President, Patient Services. We can all be very encouraged that these two therapies had an additive effect in the mice without significant adverse events or side effects.

The next steps are to encourage and support replication animal studies and to consider clinical trials with creatine and minocycline in people with ALS. Although both creatine and minocycline (physician prescription required) are currently available, ALSA stresses the importance of consulting with your ALS physician before starting any treatment.

Both creatine and minocycline are in clinical trials now as sole therapies. The results of these studies will be important in determining if the combination of the two may benefit people with ALS. An important distinction between the animal study and human trials is that the combination treatment was begun with the mice before the onset of symptoms of the disease.

Combination therapy for ALS has long been a goal in the ALS community and this study is an exciting sign that the hope may be realized soon. The ALS Association's Drug Company Working Group convenes researchers, clinicians and pharmaceutical companies to encourage ALS drug development and establish relationships to facilitate combination therapies in ALS.

The ALS Association (ALSA) is the only national not-for-profit voluntary health organization dedicated solely to the fight against amyotrophic lateral sclerosis, ALS (often called Lou Gehrig's disease). The mission of The ALS Association is to find a cure for and improve living with ALS. The ALS Association seeks to promote awareness and understanding of ALS and the work of The ALS Association by providing up-to-date information and education materials to the ALS community including ALS patients and families, caregivers, researchers and members in the health care fields.

www.alsa.org