Ethyl-EPA reduces cerebral atrophy in HD patients

HD Lighthouse Contributing Editor's Comment: 

The jury is still out on whether ethyl-EPA is helpful to HD patients but new research certainly is suggestive that it might be.  A small, randomized double-blinded study found that ethyl-EPA reduced the rate of atrophy of the head of the caudate nucleus and the posterior thalamus.

As Lighthouse readers know, the Phase III trial of ethyl-EPA Amarin's Miraxion, was not successful.  The trial was short-term, six months, and designed to see whether Miraxion would improve motor symptoms as measured by improvement in Total Motor Score 4, a subscale of the United Huntington's Disease Rating Scale.  At the end of the trial no significant differences were found.  However, a high percentage of the trial participants elected to continue and at that point all participants were given the ethyl-EPA. At the end of a year, statistically significant differences were obtained between those who had originally been on ethyl-EPA and those who were in the placebo group - even though all had been taking ethyl-EPA for the prevous six months.

The current study focuses on brain atrophy rather than symptoms.   Thirty-four stage I and II patients were randomized to receive either two grams of ethyl-EPA (Amarin’s Miraxion) or a placebo.  The study was double-blinded in that the researchers assessing the results did not know whether a participant had received ethyl-EPA or a placebo.  Magnetic resonance imaging scans were done at baseline, six months and twelve months.  A statistically significant reduction in atrophy was found for the treatment group at six months.  The rate of atrophy was similar in the two groups in the second six months.  

At this point we still do not have conclusive evidence that ethyl-EPA treats Huntington's Disease and if so, in exactly what way and for how long, but I think it should remain in the pipeline of potential treatments.

-- Marsha L. Miller, Ph.D.
Posted to the HDL: 10-13-2008

Reduction in Cerebral Atrophy Associated with Ethyl-eicosapentaenoic Acid Treatment in Patients with Huntington's Disease

BK Puri, GM Bydder, MS Manku, A Clarke, AD Waldman, CJ Beckmann

Ultra-pure ethyl-eicosapentaenoic acid (ethyl-EPA), a semi-synthetic ethyl ester of eicosapentaenoic acid, is associated with clinical improvement in motor functioning in Huntington's disease. The aim was to determine the extent to which it might reduce the rate of progress of cerebral atrophy. High-resolution cerebral magnetic resonance imaging scans were acquired at baseline, 6 months and 1 year in up to 34 patients with stage I or II Huntington's disease who took part in a randomized, double-blind, placebo-controlled trial of ethyl-EPA. For each subject and each pair of structural images, the two-timepoint brain volume change was calculated in a double-blind manner. Significant group-level reductions in brain atrophy were observed in the head of the caudate nucleus and the posterior thalamus. These findings show that treatment with ethyl-EPA is associated with significant reduction in brain atrophy, particularly in the caudate and thalamus. No other drug tested in Huntington's disease has shown this effect.

Source: The Journal of International Medical Research 2008 Sep-Oct;36(5):896-905.