Key clinical point: Treatment with hookworm was safe and possibly associated with an immunobiological effect in relapsing multiple sclerosis.
Major finding: During 3-9 months postinfection, no significant difference was detected between hookworm and placebo groups in total number of new T2 lesions, newly enhancing T1-weighted lesions, or T2 enlarging lesions. Hookworm group was somewhat less likely to have any magnetic resonance imaging activity (odds ratio, 0.33), higher percentage of CD4+CD25 highCD127negT cells in peripheral blood (4.4% vs. 3.9%; P = .01), and lower relapse rate per patient (14.3% vs. 30.6%). No patients withdrew because of adverse effects. The only differing adverse event was more application-site skin discomfort in the hookworm group (82.86% vs. 27.78%).
Study details: In this phase 2 trial, 71 patients with relapsing MS without disease-modifying treatment were randomly assigned (1:1) to receive 25 Necator americanus larvae transcutaneously or placebo.
Disclosures: This study was supported by the MS Society of the Great Britain and Northern Ireland, the Forman Hardy Charitable Trust via the University of Nottingham, and an unrestricted grant from Bayer-Schering. Some of the investigators reported receiving grants and personal fees from multiple pharmaceutical companies.
Citation: Tanasescu R et al. JAMA Neurol. 2020 Jun 15. doi: 10.1001/jamaneurol.2020.1118 .