Cooperative study in the evaluation of therapy in multiple sclerosis; ACTH vs placebo in acute exacerbations

Rose, Augustus S.; Kuzma, Jan W.; Kurtzke, John F.; Sibley, W. A.; Tourtellotte, Wallace W.; Dixon, W. J.; Foley, Joseph M.; Kane, Charles A.; Mackay, Roland P.; McDowell, Fletcher; Scheinberg, Labe C.; Schumacher, George A.; White, Philip T.

doi:10.1212/wnl.18.6_part_2.1

Cited by 80 publications

(85 citation statements)

References 7 publications

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“…MS is characterised by its chronic character with remissions occurring independently or as an effect of various treatment methods, yet in truth, currently it is only possible to apply symptomatic treatment (Bauer -1978, Rose et al -1968. Ultimately, the condition leads to physical disability upon the lapse of several years or decades.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary Clinical Study On Ms Treatment With Hyperbaric Oxygenation

Ulewicz

Masłowski

Michniewski

et al. 2015

Polish Hyperbaric Research

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The authors conducted the preliminary clinical investigation on 16 multiple sclerosis (Sclerosis multiplex) patients of median disease duration 9.33 years and symptoms evaluated on Kurtzke's scale. The patients underwent between 25 and 30 hyperbaric oxygen exposures at a pressure of 2 ata in intervals spread over a few days. The patients were qualified and classified to the treatment symptomatologically according to Fisher but the obtained results were evaluated according to the standardised Disability Status Scale by Kurtzke. During the investigations the authors carried out additional quantitative immunoglobulin and complement activity determination, lymphocyte T and B determinations as well as the usually applied clinical and laboratory investigations. Evident clinical improvement was observed in 14 patients, but in the case of one patient a deterioration was observed after 15 hyperbaric expositions (resulting in the hyperbaric oxygen treatment being stopped), whilst in another case no curative effect could be observed. By utilising the 50% haemolysis method, within the examined immunological parameters the authors observed an increase of complement fractions and its activity, white lymphocytes T and B examined qualitatively did not maintain the characteristic shift. The authors are still discussing the obtained results.

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Section: Introductionmentioning

confidence: 99%

“…Critical works on such studies (Bauer -1978, Rose et al -1968 raise accusations concerned, among other things, with the insufficient number of cases in controlled placebo groups (Fisher et al -1983, Perrins -1984, and frequently also the absence of a control group.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Clinical Study On Ms Treatment With Hyperbaric Oxygenation

Ulewicz

Masłowski

Michniewski

et al. 2015

Polish Hyperbaric Research

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“…Although back in the 1960s to the 1980s, it was a common practice to treat MS exacerbation for 4 weeks and even for as long as 35 days [12,14,21]. In the later and more recent years, significantly shorter courses of 3 to 7 days were found to be quite adequate [2,3,18,21,22,25].…”

Section: Systemic Steroids For Ms Relapse Treatmentmentioning

confidence: 99%

“…ACTH. It should be noted that the effects of IV-MP or oral high-dose MP may be delayed, therefore, in general, as a rule in our practice, we wait 2 to 3 weeks after the last dosage of high-dose corticosteroids before initiating ACTH gel therapy administered either intramuscularly or subcutaneously [44,62,63] at a dose of 80 units/day for at least 5 days and for as many as 15 days [2,13,63]. The experience in our clinic indicates that the majority of MS patients in acute exacerbation, who previously failed (did not improve) or could not tolerate the MP treatment, experienced positive clinical outcomes and fewer adverse events with ACTH gel treatment [44].…”

Section: Summary and Practical Considerationsmentioning

confidence: 99%

Treatment of Acute Relapses in Multiple Sclerosis

Berkovich

2016

Translational Neuroimmunology in Multiple Sclerosis

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“…34 -37 All of these studies were preceded by a clinical trial of ACTH compared with placebo for treatment MS attacks, a monumental milestone in the management of relapsing forms of the disorder. 38 With respect to the use of CS and ACTH for treating MS attacks, an evidence-based assessment of these agents was undertaken by the Therapeutics and Technology Assessment Committee of the American Academy of Neurology that considered disease-modifying therapies for MS. 3 In terms of using CS and ACTH, the Committee concluded as follows: 1) Treatment with CS serves to accelerate recovery from attacks of MS and that it is appropriate to consider using these agents (based on class I and II studies with a type A recommendation). 2) Long-term benefits on the disease course has not been demonstrated (Type B recommendation).…”

Section: Objectives Of Acute Intervention For Ms Exacerbationsmentioning

confidence: 99%

Corticosteroids for Multiple Sclerosis: I. Application for Treating Exacerbations

et al. 2007

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Summary:Multiple sclerosis (MS) is an inflammatory demyelinating disorder characterized by a multiphasic course of neurological exacerbations, periods of clinical remission, and, in most patients, ultimately progressive deterioration of functional capabilities. The relapsing-remitting phase of the disease involves acute interruption in neurological functioning relating to areas of inflammation in discrete central-tract systems. The treatment of MS exacerbations with anti-inflammatory agents such as corticosteroids and adrenocorticotropic hormone has represented an established practice throughout the neurology community. Although there is scientific rationale supporting application of these agents for this purpose, the broad diversity of approaches to using these drugs in clinical practice is a derivative of expert opinion and anecdotal experience. Ultimately, the treatment of MS-related exacerbations is part science, but mostly art. This review discusses the pharmacology of these agents, to better understand how they may act to mitigate attacks and to provide some practical formulations for how to use them in the clinic for the benefit of patients.

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Cooperative study in the evaluation of therapy in multiple sclerosis; ACTH vs placebo in acute exacerbations

Cited by 80 publications

References 7 publications

Preliminary Clinical Study On Ms Treatment With Hyperbaric Oxygenation

Preliminary Clinical Study On Ms Treatment With Hyperbaric Oxygenation

Treatment of Acute Relapses in Multiple Sclerosis

Corticosteroids for Multiple Sclerosis: I. Application for Treating Exacerbations

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