Endermology for treating lipoatrophy in MS’ers on glatiramer acetate

E
Lebrun et al. Endermology: A treatment for injection-induced lipoatrophy in multiple sclerosis patients treated with sub cutaneous glatiramer acetate. Clin Neurol Neurosurg. 2011 Nov;113(9):721-4.

Objective: To evaluate sessions of endermology in MS’ers with lipoatrophy, due to GA injections, in an open-labelled study. Endermology is the mechanical massaging of fatty tissue under the skin; it is a cosmetic treatment that is used to treat unsightly subcutaneous fatty tissue (cellulite).  

Endermology treatment 
Background: Glatiramer acetate (GA), an MS disease-modifying therapy, is administered as daily subcutaneous injections. The most common adverse effects, which occur in approximately 20-60% of the patients, include pain, inflammation and induration at the injection sites. Another adverse effect is frank panniculitis (inflammation of the fatty tissue under the skin) followed by localized lipoatrophy at the injection sites, which has been described in half of MS’ers receiving treatment with glatiramer acetate injections. No treatment has been found for established lipoatrophy.

“The following figures demonstrate what lipoatrophy looks like; it is the unsightly wasting of fatty tissue under the skin. This  is a common cause for MS’ers stopping treatment with the drug. In my experience this is not unique to glatiramer acetate and also occurs with subcutaneous injections of interferon beta.”

Methods: All MS’ers underwent endermology twice a week during 30min. A cycle of two months was initially proposed. If the patient was satisfied with the result, sessions were continued with one session per week until the 4th month.

Results: 8 MS’ers treated with GA and presenting with lipoatrophy were prospectively recruited. None of them complained of any adverse events. After 8 weeks of treatment, all had a visible reduction of lipoatrophic area. MRI showed no major subcutaneous changes except for a reduction in and repartition of fatty tissues.

Conclusion: The endermology treatment stimulates the skin’s surface in triggering cells to activate lipolysis and collagen production. It has never been used for treatment of lipoatrophy due to drug treatment or in specific diseases associated with lipoatrophy, for example diabetes and HIV. The prevention and management of lipoatrophy includes patient education, regular examination and manual palpation of all injection sites. Endermology may help MS’ers deal with this side effect and allow them to continue immunomodulatory treatment.

“To the best of my knowledge endermology is not available under the NHS; cosmetic therapies rarely are. However, this study is interesting as it may help with a side effect that, in my opinion, results in a small number of MS’ers stopping GA or switching to another compound not associated with this side effect.”

“Obviously this study will need to be reproduced; I would suggest with photographs of before and after, which are then presented in a random order to blinded raters, with a pre-definded rating scale, to try and improve the quality of the research.” 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

11 comments

  • Re: "Copaxone is useless. A Cochrane review supports this. So, why prescribe it in the first place?"

    I wouldn't trust every Cochrane rewiew; the Cochrane methodology is very inflexible and often ignores common sense, for example to exclude studies with sub-therapeutic doses (see IFN-beta review). Some MS'ers seem to do very well on glatiramer acetate; in my experience I would say about 15-20% respond very well. If the drug didn't work it is unlikely so many MS'ers will have stayed on the drug for so long.

    Several companies who make interferon-beta made the same mistake as you and assumed glatiramer acetate didn't work; the result was that their head-to-head studies comparing glatiramer with interferon-beta showed that glatiramer was as effective as interferon-beta.

  • Re "in my experience I would say about 15-20% respond very well"

    That's within the expected placebo effect range.

    Re "If the drug didn't work it is unlikely so many MS'ers will have stayed on the drug for so long."

    Usually, patients do what their doctor tells them. On the other hand they could falsely attribute a remission stage to drug efficacy.

  • Which brings up a very good point… Prior to going off Copaxone and DMDs in general, my wife asked her neurologist how he could tell if the drug was working. His response was, "well, we know your condition is not getting worse." To me, that is basically the same as saying I don't know. With MS how do you really know if improvements or stabilization in condition are related to the treatment or to the remission of the disease itself?

  • Re: "With MS how do you really know if improvements or stabilization in condition are related to the treatment or to the remission of the disease itself?"

    You don't really in the individual patient unless you monitor the disease very closely with MRI. This is why we rely on clinical trials to show that a drug is working; we then have to assume that if a patients responds to the drug (no disease activity) it is due to the drug. No you can see why the Pharmaceutical industry likes developing drugs for MS.

  • So, that leaves the question, how often should MRIs be performed? Our neurologist said he would not order one unless he saw enough degredation in the physical symptoms to warrant it. I'm sure our insurance providers here in the U.S. also have influence over this decision.

    But as you say, you have to make an assumption, and an assumption is quite different from knowing it is working. I also think a lot of MS patients are a bit skeptical of the clinical trials run by drug companies, because they are, in fact, run by the drug companies themselves and doctors, who in many cases, have a COI.

    When my wife went off of Copaxone a few years ago, I was against the decision. However, after seeing the improvements she has made since being off of the drug, both in physical appearance & mental state, I have to "assume" it was the right decision.

    I appreciate your response and enjoy your very comprehensive blog. Thanks for your efforts.

    • Good for her,me I thank copaxone,don’t work for everyone,because I been own it for two years ,I don’t see know improvement.

  • Re: "So, that leaves the question, how often should MRIs be performed?"

    If the results of the MRI are going to affect clinical decision making, i.e. switch, stop, start of escalate treatment, I would recommend doing an MRI annually. If it is not going to affect a decision making then there is no reason to repeat scans.

  • I have been using Copaxone for 17 years. I have had only 2 exacerbations. I have what I consider significant dimpling but I'm still ambulatory and doing very well other than the aesthetic issues.I'm very grateful for what Copaxone has provided me!

  • I've been on Avonex for five years. Almost a month ago as the needle barely broke my skin I felt severe pain. Overnight a lump appeared, pain so intense I couldn't put any weight on that leg. The pain spread to an area around the injection site about the radius of a spread open hand. A couple days later when I would sit or stand to hobble to the bathroom, a hot dog size and shape appeared by the other lump, going horizontally on my thigh. Still extreme pain. TWO visits to the er I was told I had underline infection. Two Dr visits I was told needle hit a muscle . Another said faulty needle injured muscle. Now I'm wondering if it could be this and how do i find out? Is this something that will stay now, along with the pain? What kind of Dr can help me?

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