This randomized trial looked at 244 participants with progressive multiple sclerosis who took oral ibudilast or a placebo for 96 weeks. Researchers measured changes in brain structure using brain parenchymal fraction, white matter fraction, gray matter fraction, and cortical thickness. They also analyzed blood metabolites to see how they related to brain health and drug effects.
The study found that higher baseline levels of specific lipids were linked to slower decline in overall brain tissue. Metabolites connected to gray matter preservation included androgenic steroids and steroid sulfates. Treatment with ibudilast was associated with increased levels of certain sphingomyelin species and decreased levels of anthranilate.
No safety concerns were reported in the trial data. While these findings suggest metabolomics could help predict disease progression or monitor drug effects, the results come from a single trial. Readers should understand that these are associations found in a specific group and do not prove that changing these metabolites will treat the disease.