Lithium Has Few Adverse Effects in MS; Benefits Inconsistent

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BIRMINGHAM, AL — Veterans with multiple sclerosis who were treated with lithium (Li) had few adverse events, but a consistent effect on their disease was not apparent, according to a review led by researchers from the Birmingham, AL, VAMC.

The authors of the article, published in the journal Multiple Sclerosis and Related Disorders, called for a clinical trial to ascertain Li’s effects on the MS disease course.1

Background in the article noted that lithium reduces disease activity in animal models of MS but had not been studied in human subjects. While developing a clinical trial to test the effects of Li in MS, the researchers said they performed a retrospective chart review to determine the safety and tolerability of Li among veterans with MS.

To do that, they identified all veterans with MS prescribed Li from 1998 to 2009 using the VA’s Pharmacy Benefits Management system. Charts were reviewed for Li-related adverse events and effects on the MS disease course.

Among 21,847 veterans with MS, 101 met inclusion criteria and took Li for six months or longer. Only 18% experienced an Li-associated adverse event.

Increased age of MS onset was associated with a greater risk of Li-related adverse events (p=0.004), according to study authors.

They also found that associations between Li use and MS disease activity were mixed: Li was not associated with increased risk of enhancing MRI lesions (p=0.655), but annualized relapse rates were higher on Li (0.34 vs. 0.20, p=0.044). In contrast, change in Expanded Disability Status Scale scores was greater in the off-Li period than the on-Li period (0.8 vs. 0.3, p=0.003), according to the report.

1 Rinker JR, Cossey TC, Cutter GR, Culpepper WJ. A retrospective review of lithium usage in veterans with multiple sclerosis. MSRD Journal. Volume 2, Issue 4, Pages 327-333, October 2013.

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