Immunostimulants in CFS/ME Treatment
Stimulating the Immune System Can Relieve Fatigue, Fever, Brainfog
May 13, 2009
Immunomodulators are used to influence the function of the immune system. They are generally divided into immunosuppressants and immunostimulants, though the immune system is extremely complex and the distinction isn't always clear. Almost all of the immunomodulators used in CFS/ME are considered immunostimulants.
By treating immune dysfunction immunostimulants can relieve immune symptoms like fever, often difficult to treat by other means, but also fatigue, cognitive dysfunction, sleep disturbances, post-exertional malaise and other symptoms. As a particular benefit they may stop illness progression in those with progressive CFS/ME. Immunostimulants are also indirectly antiviral.
Many other drugs can also affect the function of the immune system, including blood pressure drugs and even antidepressants.
Ampligen
Ampligen is a mismatched RNA drug with immunostimulant and antiviral properties. It has been studied in e.g. AIDS, cancer and as an adjunct to boost the efficacy of influenza vaccination. Ampligen has been in clinical trials for CFS/ME since the 1980s. It is currently waiting for FDA approval for CFS/ME.
Ampligen has to be given intravenously, though an oral version is being developed. Unfortunately it is extremely expensive. It has been available in Canada and some European countries as an orphan drug, but most patients haven't been able to afford the cost, thousands of dollars a month.
Intravenous Immunoglobulin (IVIG)
IVIG, also known as gamma globulin, is a plasma product containing pooled antibodies from thousands of blood donors. It can help even those with no detectable IgG deficiencies (though they are less likely to receive insurance coverage). It is usually given as an infusion every 3-4 weeks.
Several studies have examined the efficacy of IVIG in CFS/ME and most have found it helpful. Some doctors even consider it the single most effective treatment. It may even cure CFS/ME caused by parvovirus B19 infection. Flu-like symptoms are the most common side effects.
Low dose naltrexone (LDN)
Naltrexone is an opioid antagonist (blocker), but when used in very small doses (usually 4.5 mg, about 1/10 of the normal dose) it increases the secretion of endogenous opioid peptides like beta endorphin, which help regulate the immune system, especially boosting NK cell function. It has been successfully used in e.g. HIV/AIDS, autoimmune diseases (especially MS) and cancer.
LDN has not been studied in CFS/ME, but a recent study found it effective for relieving pain and fatigue in fibromyalgia. Side effects are very rare - in the study it was better tolerated than placebo. LDN is inexpensive and taken orally.
Nexavir
Better known with its former name Kutapressin, Nexavir is an extract of pig liver, given as an subcutaneous or intramuscular injection . It is recommended by several CFS/ME specialists like Paul Cheney and Derek Enlander. In a large study 85% of patients reported major improvement and only 16% got minor side effects - which may be the best results ever in a CFS/ME clinical trial.
Nexavir is only available in the United States. It is very expensive, but many insurance companies do cover it.
Isoprinosine
Isoprinosine (inosine pranobex) is an immunostimulant and antiviral drug which has been shown to increase NK cell activity in CFS/ME. Many experts consider it among the safest and most effective treatments for CFS/ME. It is taken orally, usually constantly varying the dose from day to day.
Isoprinosine is primarily used in Canada and Europe. It is not available in the U.S., but some patients order it from abroad. The nutritional supplement inosine may have similar effects to isoprinosine.
Vaccinations and Toxoids
Vaccinations can cause CFS/ME relapses, so it may be surprising that they've also been used as a treatment, particularly staphylococcus toxoid (inactivated bacterial toxin) and an extract of killed Mycobacterium vaccae.
No studies have been published on Mycobacterium vaccae, but several large studies done on staphylococcus toxoid in CFS/ME or fibromyalgia have found it helpful and surprisingly well tolerated. Getting either of these experimental therapies may prove difficult, however.
OTC Immunostimulant Supplements
Echinacea is a popular herb with immunostimulant properties, but is rarely considered helpful in CFS/ME. The Chinese herb astragalus (Astragalus membranaceus) may be beneficial. Some patients have noticed improvement with licorice root, which strongly simulates some parts of the immune system.
One of the most popular supplements in CFS/ME is undenatured whey protein, rich in immunoglobulins, glutamine and other immunomodulators. Many CFS/ME patients report improvement in fatigue and general well-being from taking it. A common dose is 20 grams/0.7 oz a day taken on an empty stomach.
N-Acetylcysteine (NAC) is an antioxidant and stimulates T cell function. It has been used to treat a variety of conditions, such as HIV, bipolar disorder, multiple chemical sensitivity (MCS) and Sjögren's syndrome, and some CFS/ME patients find it helpful. N-acetylcysteine is available over-the-counter in most countries.
References
Haavisto Maija. Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia. 2008.
See Also
Immunostimulant Drugs for Autoimmune Disease
