ABSTRACT
INTRODUCTION: Secondary progressive multiple sclerosis (SPMS) is the phase in which disability continues to worsen with or without accompanying attacks. Monthly methylprednisolone pulse therapy can be used in the secondary progressive phase. The purpose of the present study was to evaluate the effects of methylprednisolone pulse therapy on the basis of clinical and MRI parameters in patients with SPMS. METHODS: This was a multi-center, examiner-blinded, prospective study. Patients with SPMS with EDSS scores of 3 or more, using one or none of azathioprine, interferon or glatiramer acetate, were evaluated. Patients were given IVMP (1 dose of 1 g IV) once a month for 24 months. EDSS scores, MRI findings, quality of life, and adverse events were evaluated. RESULTS: Ninety-seven SPMS patients were included in the study. Significant decreases in new/enlarging, Gd-enhanced, and spinal lesions were observed from baseline to year 2. EDSS scores remained stable at the end of the second year. Monthly high-dose IVMP resulted in a significant decrease in attacks. CONCLUSION: This study is important in terms of emphasizing that this therapeutic option should not be overlooked, since monthly pulse therapy can halt or even reverse progression, regarded as a natural course in SPMS, albeit to a small extent.
ABSTRACT
OBJECTIVES: Multiple sclerosis is usually clinically characterized by repeated subacute relapses followed by remissions. Corticosteroids are used for relapses, and this treatment has been shown to increase the speed of recovery from these. We aimed to evaluate the efficacy and safety of pulsed methylprednisolone given every month as an add-on therapy to interferon beta or glatiramer acetate in patients with relapsing-remitting multiple sclerosis. PATIENTS AND METHODS: This was a multi-center, examiner-blinded, prospective study. Absolute annualized relapse rates and Expanded Disability Status Scale scores were calculated. RESULTS: 103 patients were given intravenous methylprednisolone (1 dose of 1g IV) once a month for 12 months as add-on therapy and were assessed during this period. The decrease in the absolute annualized relapse rate was 0.69, and 72 patients were relapse-free at the end of the year. Sixty-nine of the 103 patients had the same Expanded Disability Status Scale scores at the end of one year, while 21 were less disabled, and 13 sustained disability progression. Health related quality of life measured using the MS Quality of Life scale improved significantly during the study period. CONCLUSION: The addition of monthly pulsed methylprednisolone to subcutaneous interferon beta or glatiramer acetate therapy significantly reduced the relapse rate and may also be beneficial in terms of disease progression. These combinations were also safe, and most patients tolerated methylprednisolone as an add-on to interferon beta or glatiramer acetate.
