Autoimmune · 10 minute read
Alpha lipoic acid has passed an early checkpoint in a major MS trial. What it means, the side effects, and why it's worth waiting.
Adrian Stone, nutritionist and naturopath
In September 2026, a world-first clinical trial in progressive multiple sclerosis (MS) released its first results. One of the two treatments being tested, alpha lipoic acid, showed enough early promise to move on to the next stage. The other, the diabetes drug metformin, did not.
That’s genuinely exciting news. Alpha lipoic acid is something many people already know from the supplement shelf, so it’s no surprise the questions started rolling in. However, “early promise” and “proven treatment” are two very different things. In this post, I’ll unpack what the trial actually found, why alpha lipoic acid made sense as an MS candidate, and why it still belongs inside a trial for now.
How I weigh the evidence here. Alpha lipoic acid is a compound described by modern biochemistry, so it has no traditional-use history to set beside the research. Everything below is trial and laboratory evidence, labelled as such.
OCTOPUS is a UK-led trial that tests several candidates in progressive MS at once against one shared placebo group. Treatments that look promising stay in, those that don’t are dropped, and new ones can be added. As a result, answers can arrive years sooner than in a traditional one-drug-at-a-time trial.
University College London leads OCTOPUS, and the UK MS Society funds it. It’s the first trial of this “multi-arm, multi-stage” design in progressive MS. Researchers are now using the same approach in motor neurone disease, Parkinson’s disease and dementia.
Since launching in January 2023, OCTOPUS has recruited around 849 people with primary and secondary progressive MS across 26 UK sites.
Australia’s extension is called PLATYPUS. Professor Simon Broadley of Griffith University leads it here, with funding support from MS Australia and MSWA. The first Australian site, Gold Coast University Hospital, opened in October 2025. Sites in Perth and Hobart are expected to follow.
Stage 1 compared high-dose alpha lipoic acid and metformin with placebo, using MRI measures of brain shrinkage alongside clinical assessments. Alpha lipoic acid showed enough encouraging signals to continue into Stage 2. In contrast, metformin showed no early sign of benefit, so the team has stopped it.
Normally, you’d have to wait years to see whether a treatment slows disability. Instead, the team used brain atrophy (shrinkage) on MRI, together with clinical measures, to get an early read on each treatment.
Professor Broadley was careful with his words. “While this is not proof that it works, it’s a positive sign that it may be a benefit,” he said. Stage 2 will now test, over roughly the next three years, whether ALA actually slows the progression of disability. That’s the outcome that matters most to people living with MS.
At the time of writing, however, the team hasn’t released the detailed Stage 1 numbers. In other words, we don’t yet know the size of the effect.
Progressive MS is driven less by waves of immune inflammation and more by a slow, “smouldering” process of nerve damage. Researchers think oxidative stress and struggling mitochondria are central to it. In laboratory research, alpha lipoic acid acts at exactly that point, on mitochondrial energy production and the body’s own antioxidant defences.
To understand why ALA is in this trial, it helps to know how progressive MS differs from relapsing MS. Bursts of immune inflammation drive relapsing MS, and that’s what most current disease-modifying therapies target. In progressive MS, however, researchers describe chronic oxidative injury, activated microglia (the brain’s resident immune cells) and damaged mitochondria in nerve fibres taking over.
Here’s what the laboratory research says about alpha lipoic acid:
So seeing a mitochondrial antioxidant pass an early MRI checkpoint in a well-designed trial is an interesting signal of where the science is heading. Still, a plausible mechanism is where research starts, not where it ends.
Two earlier US trials gave a mixed picture. A small 2017 pilot found 68% less brain volume loss with lipoic acid than placebo. However, a larger 2025 trial found no benefit for walking speed, its main goal, although brain volume again looked more stable. Some people also had more protein in their urine.
The 2017 pilot study. Researchers at Oregon Health & Science University gave 51 people with secondary progressive MS either lipoic acid or placebo for two years. The lipoic acid group had 68% less brain volume loss than placebo. That was striking. Still, it was a small, single-site study.
The larger phase 2 trial (published December 2025). This study followed 115 people with progressive MS across 11 sites in the US and Canada for two years. Lipoic acid did not slow the decline in walking speed, which was the main outcome. Nor did it improve other clinical or patient-reported measures. On the other hand, whole-brain volume appeared stable in the lipoic acid group while trending down on placebo. Notably, the lipoic acid group also had more protein in their urine (proteinuria). They also dropped out more often: 37% compared with 17%.
In other words, the brain imaging signals look encouraging, but a clear clinical benefit hasn’t been shown yet. That’s why OCTOPUS Stage 2 matters. It’s large enough, and long enough, to answer the question properly.
As I often tell my patients, the path to progress is never linear. Research is no different.
Not on your own, and not for MS without your neurologist involved. MS Australia and the UK MS Society both warn that using anything not approved for MS outside a clinical trial can put you at risk. The trial doses are high, and participants are closely monitored for side effects.
Here’s why I agree, including the alpha lipoic acid side effects the trials picked up:
If you’ve already started taking lipoic acid, tell your neurologist, because of the kidney monitoring and trial eligibility points above.
If you’re already enrolled in OCTOPUS or PLATYPUS, keep taking your trial treatment and attending your visits until the team contacts you. Every participant’s data is what will give us a real answer.
If you live with primary or secondary progressive MS, you can check your eligibility and register your interest in PLATYPUS through MS Australia. The trial is open at Gold Coast University Hospital, with more Australian sites being set up. Talk it through with your neurologist or MS nurse too.
You can register your interest here: MS Australia, PLATYPUS register your interest. MS Australia also lists the trial sites as they open, so if there’s no site near you yet, it’s worth checking back.
It’s also worth asking your neurologist or MS nurse whether a trial is right for you. They know your history, your current treatment and what a trial would ask of you. Keep in mind that starting alpha lipoic acid on your own could rule you out of an MS trial.
Your neurologist leads your MS care. Our role sits alongside it: diet, lifestyle and the everyday foundations of health, plus a careful look at everything you already take. That way, anything new you’re considering, alpha lipoic acid included, gets raised with your MS team before it starts.
Oxidative stress is one of the four root drivers I see in almost every case in clinic, alongside chronic inflammation, nutritional-genetic mismatch and a stress-dominant nervous system. In practice, my part is two things. First, diet and lifestyle support: nutrition, sleep, stress and those four drivers, worked through alongside your neurologist’s care. Second, a check of the supplements and medicines you already take, so nothing doubles up and nothing new starts without your neurologist knowing.
If the gut side of MS interests you, I’ve also written about what the gut microbiome says about multiple sclerosis.
We don’t diagnose or treat multiple sclerosis; that stays with your doctor. Our part is the nutritional, herbal and lifestyle work that sits alongside their care.
General information only, not individual medical advice. Always discuss supplements and herbal medicines with your treating practitioner.
No. Alpha lipoic acid passed Stage 1 of the OCTOPUS trial, which means it showed enough early promise to keep testing. It is not approved for MS, and the larger 2025 trial found no benefit for walking speed. Stage 2 will test whether it slows disability over about three years.
The most common side effect in the MS trials was stomach upset. The 2025 trial also found more protein in the urine (proteinuria), and two people in the 2017 pilot had kidney problems. Lipoic acid can also affect blood sugar, which matters if you take diabetes medication.
Don’t start it without talking to your neurologist first. MS organisations advise against using anything not approved for MS outside a trial. It may interact with other medicines, and taking it now could rule you out of the PLATYPUS trial.
Stage 2 has only just begun. Professor Simon Broadley expects it to test ALA over roughly the next three years. Data from both stages will then be combined to give a definitive answer on whether it slows disability.
Adults living with primary or secondary progressive MS can check their eligibility through MS Australia’s register-your-interest page. The first site is Gold Coast University Hospital, with Perth and Hobart expected next.
Spain R, Powers K, Murchison C, et al. Lipoic acid in secondary progressive MS: a randomized controlled pilot trial. Neurology: Neuroimmunology & Neuroinflammation. 2017;4(5):e374. doi:10.1212/NXI.0000000000000374
Spain RI, Paz Soldán MM, Freedman MS, et al. Lipoic acid for treatment of progressive multiple sclerosis: a phase 2 randomized clinical trial. Neurology. 2026;106(1):e214454. doi:10.1212/WNL.0000000000214454
Cameron M, Taylor C, Lapidus J, et al. Gastrointestinal tolerability and absorption of R- versus R,S-lipoic acid in progressive multiple sclerosis: a randomized crossover trial. Journal of Clinical Pharmacology. 2020;60(8):1099-1106. doi:10.1002/jcph.1605
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Mahad DH, Trapp BD, Lassmann H. Pathological mechanisms in progressive multiple sclerosis. The Lancet Neurology. 2015;14(2):183-193. doi:10.1016/S1474-4422(14)70256-X
Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochimica et Biophysica Acta. 2009;1790(10):1149-1160. doi:10.1016/j.bbagen.2009.07.026
Marracci GH, Jones RE, McKeon GP, Bourdette DN. Alpha lipoic acid inhibits T cell migration into the spinal cord and suppresses and treats experimental autoimmune encephalomyelitis. Journal of Neuroimmunology. 2002;131(1-2):104-114. doi:10.1016/s0165-5728(02)00269-2
Wade C, Apap Mangion S, Chataway J. Adaptive trials and new designs. Revue Neurologique. 2026;182(5):428-432. doi:10.1016/j.neurol.2026.02.155
Malhotra P, Pal S, Tallantyre E, et al. Multi-arm multi-stage platform trials for neurological disease: accelerating progress. The Lancet. 2026;407(10544):2154-2156. doi:10.1016/S0140-6736(26)00978-5
MS Australia. Alpha lipoic acid shows promise in Stage 1 of Octopus trial in progressive MS. 17 September 2026. msaustralia.org.au
Griffith University. Early results show world-first adaptive trial in action for progressive MS. 18 September 2026. news.griffith.edu.au
UK MS Register. Alpha-lipoic acid moves to the next stage of the Octopus trial. September 2026. blog.msregister.org
General information only, not individual medical advice. Always discuss supplements and herbal medicines with your treating practitioner.
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