MD1003 (biotin)

Other names: Qizenday


MD1003 is a highly concentrated formulation of biotin which was investigated as a treatment for secondary and primary progressive multiple sclerosis.

  • Biotin activates enzymes involved in cellular energy production and myelin synthesis.
  • A small pilot study provided initial evidence that high doses of biotin might have an impact on disability and progression.
  • A clinical trial in secondary and primary progressive MS failed to show that biotin leads to improvements in disability.
  • No further clinical trials are planned.

How does MD1003 work?

Biotin, also known as vitamin H or coenzyme R, is one of the B-group vitamins (vitamin B7). It is necessary for cell growth, the production of fatty acids, and the metabolism of fats and amino acids, the building blocks of proteins. At the cellular level, it activates enzymes involved in energy production and synthesis of myelin.

Very high doses of biotin may be effective in MS by promoting myelin repair through activation of an enzyme involved in myelin synthesis and by enhancing energy production in demyelinated nerves.

MD1003 is a highly-concentrated formulation of biotin. The dose used in clinical trials corresponds to 10,000 times the recommended daily intake of biotin. Neurologists warned that people should not start taking large quantities of biotin supplements which are manufactured to a lower quality than the pharmaceutical grade biotin which was used for clinical studies.

How is MD1003 taken?

MD1003 is taken by mouth, as a capsule, three times a day.

MD1003 research

What are the results so far?

A small pilot study of 23 people with primary and secondary progressive MS provided initial evidence of effectiveness and safety of high doses of biotin. This was an open study - in other words both the people with MS and their doctors knew what treatment they were receiving; this can bias the results. Participants were treated with high doses of biotin (100-300 mg/day) for 2 to 36 months (average of 9.2 months). 21 out of 23 participants showed evidence of improved disability, 2 to 8 months after starting treatment.

In another small open study, 43 people with progressive MS took a single daily dose of 300mg high dose biotin for one year. Disability levels (EDSS) were recorded at the start and every three months. None of the participants' EDSS scores improved. One-third (38-43%) worsened, most often with increased leg weakness, worsened balance, and more falling.

MS-SPI - MD1003 compared to placebo in primary and secondary progressive MS

Investigators recruited 154 people with secondary or primary progressive MS who were having increasing difficulty with walking and leg weakness (EDSS 4.5 - 7).

Participants took either MD1003 or placebo for the first 12 months, then all participants took MD1003 for a further 12 months. Participants continued with any medications or other treatments they were already taking. Approximately half of the participants in each group were taking fampridine, and approximately 40% in each group were taking a disease modifying drug.

The main measure of the study was improvement in disability after 9 months of treatment which was still evident at 12 months. Improvement in disability could be either a reduction in EDSS or a reduction in the time to walk 25 feet. Slightly less than 13% of the MD1003 group and none of the placebo group met this criteria.

At month 24, 14 of 91 (15%) participants taking MD1003 throughout the study and 5 of 42 (12%) of participants who switched to MD1003 had reduced MS-related disability.

MS-ON - MD1003 compared to placebo in chronic visual loss related to optic neuritis in multiple sclerosis

This phase III trial recruited 93 people with long term visual problems resulting from multiple sclerosis related optic neuritis. Participants took 300mg/day MD1003 or placebo for 24 weeks, followed by all participants receiving MD1003 for another 24 weeks. People taking MD1003 improved slightly more than those in the placebo group, though the difference was not statistically significant.

SPI2 - MD1003 compared to placebo in primary and secondary progressive MS

This phase III study compared MD1003 or placebo in 642 people with primary or secondary progressive MS. Compared to placebo, MD1003 had no significant effect on EDSS score or time taken to walk 25 feet; the researchers concluded there was no improvement in disability.

Side effects

In the MS-SPI study there were no serious side effects. Mild to moderate side effects included urinary tract infections and headache and were reported for both placebo and MD1003 groups, suggesting that side effects were not caused by biotin.

High levels of biotin in the blood can interfere with laboratory tests and cause incorrect test results which may go undetected and could lead to misdiagnosis and inappropriate treatments. Anyone taking biotin should tell their health team.

Sedel F, et al.
High doses of biotin in chronic progressive multiple sclerosis: A pilot study.
Multiple Sclerosis and Related Disorders 2015;4:159-169.
Full article (link is external)
Tourbah A, et al.
MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: a randomised, double-blind, placebo-controlled study.
Multiple Sclerosis Journal 2016; 22: 1719-1731.
Full article (link is external)
Birnbaum G, et al.
High dose biotin as treatment for progressive multiple sclerosis.
Mult Scler Relat Disord. 2017 Nov;18:141-143.
Summary (link is external)
Biotin (Vitamin B7): Safety Communication - May Interfere with Lab Tests
Tourbah A, et al.
MD1003 (high-dose pharmaceutical-grade biotin) for the treatment of chronic visual loss related to optic neuritis in multiple sclerosis: a randomized, double-blind, placebo-controlled study.
CNS Drugs. 2018;32:661-672
Full article (link is external)
Cree, B, et al.
Safety and efficacy of MD1003 (high-dose biotin) in patients with progressive multiple sclerosis (SPI2): a randomised, double-blind, placebo-controlled, phase 3 trial
Lancet Neurology. 2020;19(12):988-997.
Summary (link is external)
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