High dose biotin as treatment for progressive multiple sclerosis

Mult Scler Relat Disord. 2017 Nov;18:141-143. doi: 10.1016/j.msard.2017.09.030. Epub 2017 Sep 29.

Abstract

Background: Published data suggested high dose biotin improved patients with progressive MS. We wished to determine benefits and side effects of administering daily high dose biotin to patients with progressive multiple sclerosis in a large MS specialty clinic.

Methods: Forty-three patients with progressive multiple scleroses were prescribed pharmaceutical grade biotin as a single daily dose of 300mg/day. Brain MRIs were performed at baseline and after one year on biotin. Quantitative neurologic exams (EDSS) and blood work monitoring for biotin toxicity were performed at baseline and every three months thereafter.

Results: High dose biotin was safe, and well tolerated, with no evidence of toxicity on blood work and no new lesions on brain MRIs. None of the patients' EDSS scores improved. One-third of patients (38-43%) worsened, most often with increased lower extremity weakness, worsened balance, and more falling, with two patients worsening sufficiently to increase their EDSS scores by 0.5. Several worsened patients improved after stopping biotin.

Conclusion: High dose biotin was safe and well tolerated, but of no demonstrable long-term benefit. More than one-third of patients worsened while on biotin, most likely due to their disease, but in some patients also possibly due to the inability of their injured central nervous systems to respond to the increased metabolic demands induced by biotin.

Keywords: Biotin; Multiple sclerosis; Progressive multiple sclerosis.

MeSH terms

  • Biotin / administration & dosage*
  • Biotin / adverse effects
  • Brain / diagnostic imaging
  • Brain / drug effects
  • Disability Evaluation
  • Facial Pain / chemically induced
  • Female
  • Humans
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Male
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / blood
  • Multiple Sclerosis, Chronic Progressive / diagnostic imaging
  • Multiple Sclerosis, Chronic Progressive / drug therapy*
  • Multiple Sclerosis, Relapsing-Remitting / blood
  • Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Treatment Failure
  • Vitamin B Complex / administration & dosage*
  • Vitamin B Complex / adverse effects

Substances

  • Immunologic Factors
  • Vitamin B Complex
  • Biotin