Golianovskyi, O. V., Andrienko, O. O., Furman, O. V., & Boyle, P. (2020). Prospective of low dose naltrexone use in treatment of autoimmune pathology and endometriosis. Reproductive Endocrinology. https://doi.org/10.18370/2309-4117.2020.55.53-57
Golianovskyi OV, Andrienko OO, Furman OV, Boyle P. Prospective of low dose naltrexone use in treatment of autoimmune pathology and endometriosis. Reproductive Endocrinology. 2020. doi:10.18370/2309-4117.2020.55.53-57
Golianovskyi, O. V., et al. "Prospective of low dose naltrexone use in treatment of autoimmune pathology and endometriosis." Reproductive Endocrinology, 2020.
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National Pirogov Memorial Medical University, Vinnytsya03bcjfh39
Low dose naltrexone may help endometriosis, a 2020 review proposes
A 2020 literature review by four authors proposes that low dose naltrexone may help manage endometriosis. It draws on Crohn's disease and multiple sclerosis trials. In one Crohn's trial, 88 out of 100 on low dose naltrexone responded, against 40 out of 100 on placebo.
Key Findings
In a randomized placebo-controlled trial of Crohn's patients resistant to usual treatment, clinical response was 88% with naltrexone against 40% with placebo (p = 0.009).
The same trial found endoscopic response in 78% against 28% (p = 0.008), and remission in 33% against 6%.
In a placebo-controlled multiple sclerosis trial of 60 participants over 8 weeks, the paper reports significant improvement in mental health and quality of life components.
In a retrospective review of 215 multiple sclerosis patients, 77% reported no side effects, 6% reported insomnia and 5% reported unpleasant dreams.
A systematic review and meta-analysis found no evidence of a difference in serious adverse reactions between oral naltrexone and placebo.
Interpretation
The paper is a narrative literature review. The authors searched two databases and describe selected studies without pooling results. The endometriosis link is a proposal, and the review reports no endometriosis trial. The Crohn's and multiple sclerosis evidence mixes two randomized placebo-controlled trials, open-label pilot studies, one retrospective review and a single case report. The pregnancy study it cites used a higher dose.
RRM Context
Restorative reproductive medicine looks for the cause of endometriosis, and excision is the surgical standard. The review calls naltrexone a non-hormonal medicine. It cites earlier work on low endorphin levels in endometriosis. Testing the idea takes a trial in women with endometriosis.
Our editorial summary of this paper, not the article's abstract.
Abstract
There are still many complex issues in the management of autoimmune pathologies in gynecology and reproductology, endometriosis in particular. Naltrexone, a competitive antagonist of opiate receptors in the central and peripheral nervous systems, reveals new qualities such as effects on autoimmune processes. Naltrexone in low doses of 1.7–5 mg (Low Dose Naltrexone, LDN) revealed the opposite effect on opiate receptors in the form of a rebound effect and, as a consequence, a strong increase in endogenous endorphins and enkephalins. Studies of elevated levels of these neurotransmitters have provided evidence of a multidisciplinary beneficial effect on the immune system of people with endorphin and enkephalin deficiency, an association between the endogenous opiate system and cells and tissue growth in general and healthy immune function was confirmed. The most explored effects of them are such as blocking the synthesis ofpro inflammatory cytokines IL-6, IL-12, tumor necrosis factor, the effect on neuroglia through toll-like receptors, the effect on the cycle cells growth, especially malignant tumor cells, through interaction with opiate growth factor, modulation synthesis of T- and B-lymphocytes. Growing evidence of LDN efficacy is becoming a potentially effective clinical practice in autoimmune pathologies, but still off-label used.Some data of clinical trials is presented. Four studies with Crohn's disease with results of relief of symptoms and remission, including experience in pediatrics. Three clinical trials with LDN results in multiple sclerosis with improved quality of life and improved symptoms. The scientific hypothesis suggests the success of LDN due to the reduction of induced nitric oxide synthase activity. The success of management of patients with malignant tumors is also presented. The article contains the latest data from clinical trials on reported serious and non-serious side effects of naltrexone at various doses, including data confirming the safety of taking mid-therapeutic naltrexone doses throughout pregnancy. These effects of LDN may prove to be effective in management patients with endometriosis.
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