How High Doses of Biotin May Treat Progressive MS

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If you or a loved one has progressive MS, you may feel worried or even frustrated that there are no approved medications for your disease type. But rest assured, researchers are working hard, and therapies are emerging.

One such therapy is a high dose formulation of the vitamin biotin. Let's take a closer look at the scientific research behind biotin in treating progressive multiple sclerosis.

How Progressive MS Is Different From Relapsing-Remitting MS

While the majority of people with multiple sclerosis have relapsing-remitting MS (about 85 percent), a small subset (about 10 to 15 percent) have primary progressive MS.

This means that they do not experience the classic relapses of neurological dysfunction.

The biology behind an MS relapse is that a person's immune system attacks the myelin sheath. In other words, a relapse is an inflammation-driven process. But in progressive MS, a less inflammatory and more degenerative process occurs, whereby nerve fibers gradually deteriorate. So a person with progressive MS experiences steadily worsening neurological dysfunction without periods of remission.

The term secondary progressive MS describes a person who once experienced relapses, but has now switched to a gradual, progressive MS course. The majority of people with relapsing-remitting MS eventually transition to secondary progressive MS. Although, this may be changing with the use of early disease-modifying therapies.

Biotin as a Potential Therapy for Progressive MS

Since current disease-modifying therapies (which target a person's immune system) are not effective in treating progressive MS (unless a person still experiences some relapses), researchers have been trying to find therapies that can target the progressive pattern of multiple sclerosis.

In other words, a drug that targets the central nervous system and not the immune system.

To researchers, the vitamin biotin seemed like a reasonable option, considering it has been found to effectively treat other severe central nervous system disorders in high doses. Scientifically speaking, how would biotin help a person's progressive MS?

Biotin plays a role in making fatty acids in the body, and the myelin sheath is a fatty covering. So, scientists speculate that biotin may activate the synthesis of fatty acids, which can lead to myelin repair and also protect against nerve fiber damage and loss.

The Research Behind Biotin in Progressive MS

The first study that examined treating progressive MS with biotin was a French study in Multiple Sclerosis and Related Disorders. In this study, 23 people with either primary progressive (14 people) or secondary progressive MS (9 people) were given high doses of biotin daily (100mg to 600mg) for an average of approximately 9 months.

Results of the study revealed the following:

  • Four people had chronic vision loss from MS-related optic nerve disease prior to the study. All had visual acuity improvement with high dose biotin (300mg/day).
  • One person had a left homonymous hemianopia prior to the study (meaning the left side of each eye was not seeing properly). This person had vision improvement, although the correlating lesion on his brain MRI remained unchanged.
  • 18 people had spinal cord involvement prior to the study—11 people with worsening tetraparesis (partial or complete paralysis of four limbs) and seven people with paraparesis (partial or complete paralysis of two limbs). 16 of these 18 people (89 percent) had improvement (occurring two to eight months after biotin treatment began).

    Of those who improved (which was reported by a blinded examiner reviewing videotapes of the participant's clinical examination), optimal improvement was seen with higher doses of biotin, at 300mg/day.

    Some other MS-related symptoms and signs that improved included:

    Finally, disability, as measured by the EDSS score, improved in four of the 23 people (22 percent).

    The only adverse effect reported in the study was transient diarrhea in two of the people.

    One person died from heart failure three years after starting biotin therapy and one year after therapy began, a person died from pneumonia after undergoing colon surgery. Both instances of death were not believed to be related to treatment with biotin.

    Also, remember that people with progressive MS can still experience occasional relapses. In the study, four people (13 percent) experienced at least one MS relapse. But according to the researchers, this number was similar to what was observed in these people prior to treatment with biotin. In other words, biotin did not appear to negatively or positively impact the occurrence of MS relapses.

    Another Biotin Study for Treating Progressive MS

    In another French study in Multiple Sclerosis, people with either primary or secondary progressive MS were randomized to receive either 100mg biotin or placebo (pills looked and tasted exactly the same) three times daily (so a total of 300mg biotin daily, if not the placebo).

    The study participants nor the study investigators knew who received the biotin pill and who received the placebo pill. This was done for one year (called the first phase). In the end, 91 people received the biotin pill and 42 people received the placebo pill.

    Then for another year, all of the participants (including the original placebo participants) received 100mg biotin three times daily (called the extension phase). They still did not know whether they had received the biotin the first year or placebo.

    Results revealed that 13 (12.6 percent) of the participants treated with biotin from the start had a decrease in their MS-related disability, and 10 of these 13 participants had continued improvement through the end of the study (24 months). Two people who received biotin in the first phase did not show improvement in the first 12 months but did by the end of the 24 months.

    Disability improvement was measured by either a decrease in the EDSS score and/or a reduction in the time it took to walk 25 feet. The kicker here is that there was no improvement in the placebo group, suggesting that biotin did have a true effect. Also, similar to the first study mentioned, biotin was well-tolerated, without any serious side effects.

    This all being said, one concerning issue mentioned by the study authors is that those who received biotin had more new or enlarging brain lesions (as seen on MRI) than those in the placebo group. So the question arises whether biotin is triggering relapses by activating a person's immune system? This is why more research is needed.

    A Word From Verywell

    What do these studies suggest? They suggest that biotin may safely and effectively help reverse the progression of disability in people with primary or secondary progressive MS. Still, though, more extensive and thorough research needs to be done before any conclusions can be drawn. For instance, it would be useful to look at brain lesions on MRIs in future studies.

    Also, emerging research shows that biotin may not be effective in treating visual acuity, which makes experts scratch their heads a bit. Overall, larger studies need to be completed to tease out the true benefit of biotin in multiple sclerosis. This is a tedious process, and while time-consuming, it really is in your or your loved one's best interest.

    Sources:

    National MS Society. Frequently Asked Questions About SPMS.

    Sedel F et al. High doses of biotin in chronic progressive multiple sclerosis: a pilot study. Mult Scler Relat Disord. 2015 Mar;4(2):159-69.

    Tourbah A et al. MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: A randomized, double-blind, placebo-controlled study. Mult Scler. 2016 Nov;22(13):1719-31.

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