A randomized double-blind placebo-controlled trial of low-dose interleukin-2 in relapsing-remitting multiple sclerosis

BackgroundMultiple sclerosis (MS) is associated with regulatory T cells (Tregs) insufficiency while low-dose interleukin-2 (IL2(LD)) activates Tregs and reduces disease activity in autoimmune diseases.MethodsWe aimed at addressing whether IL2(LD) improved Tregs from MS patients. MS-IL2 was a single-center double-blind phase-2 study. Thirty patients (mean [SD] age 36.8 years [8.3], 16 female) with relapsing-remitting MS with new MRI lesions within 6 months before inclusion were randomly assigned in a 1:1 ratio to placebo or IL-2 at 1 million IU, daily for 5 days and then fortnightly for 6 months. The primary endpoint was change in Tregs at day-5.ResultsUnlike previous trials of IL2(LD) in more than 20 different autoimmune diseases, Tregs were not expanded at day-5 in IL2(LD) group, but only at day-15 (median [IQR] fold change from baseline: 1.26 [1.21-1.33] in IL2(LD) group; 1.01 [0.95-1.05] in placebo group, p < 0.001). At day-5, however, Tregs had acquired an activated phenotype (fold change of CD25 expression in Tregs: 2.17 [1.70-3.55] in IL2(LD) versus 0.97 [0.86-1.28] in placebo group, p < 0.0001). Regulator/effector T cells ratio remained elevated throughout treatment period in the IL2(LD) group (p < 0.001). Number of new active brain lesions and of relapses tended to be reduced in IL2(LD) treated patients, but the difference did not reach significance in this trial not powered to detect clinical efficacy.ConclusionThe effect of IL2(LD) on Tregs in MS patients was modest and delayed, compared to other auto-immune diseases. This, together with findings that Tregs improve remyelination in MS models and recent reports of IL2(LD) efficacy in amyotrophic lateral sclerosis, warrants larger studies of IL2(LD) in MS, notably with increased dosages and/or modified modalities of administration.

Automated summary

The effect of low-dose interleukin-2 (IL2(LD)) treatment on regulatory T cells (Tregs) in multiple sclerosis (MS) patients was modest and delayed, compared to other autoimmune diseases. Larger studies with increased dosages and/or modified modalities of administration are needed.