Evaluate remyelination benefit of vaginal estriol adjunctive therapy in patient with relapsing remitting multiple sclerosis.

Multiple sclerosis is a chronic immune mediated condition that leads to demyelination. Remyelination in MS is incomplete and inadequate, understanding the mechanism of regeneration failure are one of the main focus in MS therapies. Estriol has anti-inflammatory properties, facilitates remyelinating process through enhancing oligodendrocyte precursor cell regeneration.  

Prolongation of the P100 latency of the visual evoked potential (VEP) has long been used to detect subclinical demyelinating lesions in MS. Optical coherence tomography (OCT) offers a non-invasive measurement if the retinal nerve fiber layer thickness, both have been used in previous studies to evaluate remyelination outcomes.

Pilot study at TTUHSC department of neurology, MS clinic.  Adjunctive vaginal estriol (1mg) was offered to patient with RRMS.  MRI brain with and without contrast, VEP and OCT obtained at baseline and 9 months. Multiple sclerosis quality of life-54(MSQOL-54) mental and physical were performed at first encounter and 9 months. Vaginal estriol is absorbed more naturally, levels of FSH, estriol and LH were done at baseline and 9 months.

Statistically significant improvement observed for VEP Left Eye (p = 0.031), OCT MRNFL Left Eye (p = 0.005), Flair Lesions (p = 0.018), MSQoL 54 Physical (p = 0.009), and MSQoL 54 Mental (p = 0.042). were observed after 9 months of estriol. Diminished burden of disease was appreciated in MRI brain at 12 months, no significant changes in T1 black holes. Statistically ignificant improvements of MSQol-54 quality of life mental and physical were observed after 9 months of vaginal estriol.

Adjunctive treatment of vaginal estriol showed beneficial effects in remyelination and improved functional outcome in relapsing remitting multiple sclerosis patients.