Bazedoxifene Acetate as a Remyelinating Agent in Multiple Sclerosis

Expanded Inclusion Criteria:

Relapsing remitting Multiple Sclerosis by 2017 Revised McDonald Criteria
Women aged 45-65 or 40+ post-menopausal.
Stable immunomodulatory therapy - no switch or planned switch in < 6 months and no change in doses in 30 days prior to screening
Use of contraceptive method with ≤1% failure rate during period of trial if premenopausal
Understand and sign informed consent.
EDSS 0-6.0 (inclusive)

Chronic Optic Neuropathy Subgroup Inclusion Criteria (including broader inclusion criteria):

Expanded inclusion criteria
Latency delay > 118 milliseconds on baseline full-field transient pattern reversal VEP in at least one eye (electrophysiological evidence of demyelination)

Expanded Exclusion Criteria:

Multiple Sclerosis disease duration > 25 years
History of significant cardiac conduction block
Patients with a known, suspected or past history of breast, gynecological, or gastrointestinal cancer
Suicidal ideation or behavior in 6 months prior to baseline
Pregnancy, breastfeeding, or planning to become pregnant
Included with other study protocol simultaneously without prior approval
Concomitant or prior use of any other putative remyelinating therapy as determined by investigator, including but not limited to Clemastine, Duavee, and Tamoxifen.
Serum creatinine > 1.5mg/dL; AST, ALT, or alkaline phosphatase > 2 times the upper limit of normal
History of drug or alcohol abuse within the past year
Untreated B12 deficiency (as determined by B12 serological assessments and metabolites including methylmalonic acid [MMA] and homocysteine) or untreated hypothyroidism
Clinically significant cardiac, metabolic, hematologic, hepatic, immunologic, urologic, endocrinologic, neurologic, pulmonary, psychiatric, dermatologic, allergic, renal or other major diseases that in the PI's judgement may affect interpretation of study results or patient safety.
History of or presence of clinically significant medical illness or laboratory abnormality that, in the opinion of the investigator would preclude participation in the study.
Patients whose lack of mobility exposes them to an increased risk of venous thromboembolism
Patients with undiagnosed uterine bleeding
Patients with unknown, suspected or past history of breast cancer
Patients with known or suspected estrogen-dependent neoplasia
Patients with active or a past history of venous thromboembolism
Patients with active or a past history of arterial thromboembolism
Patients with known protein C, protein S, or antithrombin deficiency or other known thrombophilic disorders
Patients with hypersensitivity (angioedema, anaphylaxis) to estrogens, bazedoxifene, or any ingredients
Patients with known hepatic impairment or disease

Chronic Optic Neuropathy Subgroup Exclusion Criteria:

Expanded exclusion criteria
Optic neuritis in prior 6 months
Known optic neuritis in involved eye ≥ 15 years ago
Major ophthalmologic disease/Concomitant ophthalmologic disorders (e.g. diabetes, macular degeneration, glaucoma, severe myopia, etc.).
Myopia > -7 Diopters (severe myopia)
Disc hemorrhages in qualifying eye
No light perception in qualifying eye
Simultaneous bilateral optic neuritis
Cotton wool spots in qualifying eye
Macular star in qualifying eye