We addressed this issue on facebook 17th December but I know many of you haven't seen it as we have had several emails.
Two of our medical advisers Dr Tom Gilhooly and Pharmacists Stephen Dickson give their comments.
Rebif + LDN why does it appear to be OK to take together in practice?
Dr Tom Gilhooly's comments......There is no evidence that Rebif and LDN cannot be taken together and many patients have used this combination. As they are both immune modulators, this would make sense.
Stephen Dickson comments......This is actually a difficult question - that involves a degree of conjecture.
Firstly, the easiest way to answer this question is probably by examining the current reason why some doctors state that Rebif should not be taken with LDN.
Some physicians have theorised that Interferon *suppresses* the immune system, and acts in a similar way to taking a low dose of steroids - thereby reducing the activity of the immune system, and the formation of lesions/number of relapses. As this is the "opposite" of the proposed mode of action of LDN, they say that the two treatments are incompatible.
In truth, the mechanism of action of Interferon beta -1a (Rebif) is not clearly defined -here is an extract from the product characteristics:
Q. How does Rebif work?
A. The precise way Rebif works is not known. Interferons, like Rebif, have many actions that affect the immune system. Some of these properties are thought to maintain and preserve nerve function. In this way, Rebif may help reduce the damage to the vital components of the central nervous system. Although there is no cure forMS, Rebif has been proven to slow the course of the disease.
Full article available here:
So it can be concluded that the original stipulation that Interferon beta 1a is an immunosuppressant, is probably incorrect - as the mechanism of action is not clearly defined.
The true story is probably much more complicated - as interferon has a variety of actions in different cell groups. Some pro-and some suppressor.
In the same way, LDN has been proposed as an immuno-stimulant - via a mechanism of endorphin stimulation.
This is, once again, not entirely true - there has been no significant study that actually clearly demonstrates this full mechanism of action - the true story is likely to be somewhere in the middle.
For example, here is an article showing an immunosuppressant activity from opiate mediated endorphins:
In this study we show that the opioid peptide β-endorphin exerts a tonic inhibitory effect on the proliferative response of splenocytes to the polyclonal mitogen phytohemoagglutinin throughout two separate sites of action: one central and one peripheral.
It is true that patients who take LDN, seem to exhibit signs of an improved immune function - however, this could be a mixture of "upregulating" good cells and "downregulating" bad/damaged/malfunctioning cells.
In conclusion, there is no clear evidence to prohibit the use of Rebif and LDN at the same time - so we must look to the evidence available from patients who have taken both.
It is clear that some patients who have taken both LDN and Rebif have had improved responses compared to people on either treatment alone. Personally we know of quite a few in the UK, and I am the LDN research trust has heard of many more. We have heard of effects like reduced side effects from rebif, longer times between relapse etc.
Finally, the personal test, if I had MS would I take both together?
The answer for me, personally, is yes.
LDN, Rebif, Interferon Drugs- can they be taken together?
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