A randomized clinical trial of oral versus intravenous methylprednisolone for relapse of MS

Ramo-Tello, Cristina; Grau-López, Laia; Tintoré, Mar; Rovira, Àlex; Torrentà, Lluís Ramió; Brieva, Luís; Cano, Antonio; Carmona, Olga; Sáiz, Albert; Torres, Ferrán; Giner, Pilar; Nos, Carlos; Massuet, Anna; Montalbán, X; Martínez-Cáceres, Eva; Costa, Joan

doi:10.1177/1352458513508835

Cited by 64 publications

(85 citation statements)

References 34 publications

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“…Oral prednisone, starting at 1 mg/kg/day and tapered over 1-4 weeks, is considered for patients with incomplete resolution of symptoms after IV treatment. There is evidence that high-dose oral corticosteroids (1250 mg of prednisone for adults) may be as beneficial as the IV form for treating acute inflammatory, demyelinating attacks of the CNS [46][47][48]. In children, oral steroids are less commonly used for treating an acute attack as appropriate dosing is unclear.…”

Section: Acute Management Of Demyelinating Attacksmentioning

confidence: 99%

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination.

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Section: Acute Management Of Demyelinating Attacksmentioning

confidence: 99%

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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“…No difference was found between groups regarding drug efficiency with administration of equal doses of oral and IV MP. In a well-designed study in which oral (1250 mg/per day for 3 days) and IV (1000 mg/ per day for 3 days), MP therapies were compared in 49 patients; no differences were found between the groups in the 1 st , 4 th , and 12 th weeks in terms of both reducing EDSS scores and MRI lesions (71). In some centers, oral steroid administration is increased in patients, particularly in those who do not require close monitoring.…”

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

“…However, a recently published study evaluated oral steroid administration in relapse: Relapses were identified as "severe"(increase >2.5 points on EDSS), "moderate" (increase 1-2.5 points on EDSS), and "mild" (increase ≤0.5 points on EDSS) (38).…”

mentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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“…The trial provided confirmatory evidence that bioequivalent high-dose oMP is not clinically nor radiologically inferior to ivMP, and is equally well-tolerated and safe. 2 All participants in the present study were adults who had met the 2005 McDonald criteria 3 for RRMS, and had experienced a recent (< 15 days) moderate or severe relapse. All patients had an EDSS score ⩽ 5.0, acquired in the previous 6-month relapse-free period (EDSS T-1).…”

Section: Patientsmentioning

confidence: 99%

Baseline clinical status as a predictor of methylprednisolone response in multiple sclerosis relapses

et al. 2015

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Background: To date, there are no available factors to predict the outcome after multiple sclerosis relapse. Aim: To investigate factors that may be useful for predicting response to methylprednisolone treatment, following a relapse of multiple sclerosis (MS). Methods: The study included 48 MS patients enrolled in a double-blind multicenter trial to receive intravenous versus oral high-dose methylprednisolone treatment. Associations were sought between the disability status prior to relapse and the relapse severity, determined by changes in the Expanded Disability Status Scale (EDSS) score, as well as the improvements after treatment. We also analyzed the relationships between the number of magnetic resonance imaging (MRI) gadolinium-enhancing lesions (Gd+) and improvement. Results: A higher EDSS score before relapse was associated with more severe relapses (p = 0.04) and less marked improvement (odds ratio (OR) 1.8; 95% CI (1.2-2.2); p = 0.05) after methylprednisolone treatment. Relapse severity (p = 0.29) and the number of Gd+ lesions at relapse (p = 0.41) were not related with improvement. Conclusions: Clinical baseline status prior to MS relapse is a predictor of response to methylprednisolone treatment.

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A randomized clinical trial of oral versus intravenous methylprednisolone for relapse of MS

Abstract: clinicaltrials.gov identifier: NCT00753792.

Cited by 64 publications

References 34 publications

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Baseline clinical status as a predictor of methylprednisolone response in multiple sclerosis relapses

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