Double-blind, randomized, placebo-controlled study of oral, high-dose methylprednisolone in attacks of MS

Sellebjerg, Finn; Frederiksen, Jette Lautrup; Nielsen, P.M.; Olesen, Jes

doi:10.1212/wnl.51.2.529

Cited by 133 publications

(92 citation statements)

References 9 publications

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“…In an international optic neuritis study, administration of 1 g/day IV MP for 3 days followed by 21 days of oral MP has been shown to be superior to oral MP administration alone. In another randomized, controlled, prospective study, EDSS scores were shown to significantly improve in steroid-treated groups in the 3 rd and 6 th weeks (67). Two different meta-analyses also reached similar conclusions.…”

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 65%

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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Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 65%

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

Sevim¹

2016

tnd

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“…Oral high dose methylprednisolone therapy (500 mg once daily for 5 days followed by a tapering dose over the next 10 days) has recently been shown to significantly accelerate recovery from attacks of relapsing-remitting MS, compared to placebo, 27 The treatment was generally well tolerated, although 38% of patients receiving oral high dose methylprednisolone experienced gastrointestinal symptoms. An earlier study found that oral high dose methylprednisolone therapy (500 mg daily for 5 days) was as effective as the same dose of i.v.…”

Section: Corticosteroid Therapymentioning

confidence: 99%

Recent progress in the diagnosis and treatment of multiple sclerosis

Pender

1999

Journal of Clinical Neuroscience

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Magnetic resonance imaging (MRI) now provides valuable diagnostic and prognostic information for the management of multiple sclerosis (MS) but the diagnosis still largely rests on the clinical features of central nervous system (CNS) lesions disseminated in time and place. Recent histological and MRI studies indicate that extensive axonal damage can occur in MS, even early in the disease course, and is likely to be an important cause of accumulating disability. Several immunomodulating agents have now been shown to have beneficial effects in MS. High dose intravenous or high dose oral methylprednisolone therapy accelerates recovery from attacks of relapsing-remitting MS, but at present there is no convincing evidence that standard dose (intermediate dose) oral corticosteroid therapy is beneficial for such attacks. Interferon beta, copolymer 1 (glatiramer acetate) and i.v. immunoglobulin therapy each significantly reduce the frequency of attacks of relapsing-remitting MS. Interferon beta also inhibits the progression of disability in relapsing-remitting MS and secondary progressive MS, but its effect on primary progressive MS is unknown. Oral low dose methotrexate therapy slows the progression of disability in secondary progressive MS and possibly in primary progressive MS, but it is likely that the currently used dosage (7.5 mg weekly) is suboptimal. Further research is needed to determine the optimal doses and combinations of the above therapies in MS and to develop better therapies, particularly for primary progressive MS.

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“…Overall, the four trials of MP (total n = 140) and two trials of ACTH (total n = 237) supported similar benefits of MP and ACTH in acute MS exacerbations [Durelli et al 1985;Filipovic et al 1997;Miller et al 1961;Milligan et al 1987;Rose et al 1970;Sellebjerg et al 1998]. In this review, insomnia was included in the category of psychiatric disturbances.…”

Section: Discussionmentioning

confidence: 87%

“…The available data support an association between corticosteroid treatment and mood disorders as well as other neuropsychiatric disorders such as sleep disturbances, cognitive impairment, and psychosis in some patients [Iacovides and Andreoulakis, 2011;Klein, 1992;Lewis and Smith, 1983;Lienert et al 2013;Martinelli et al 2009;Paparrigopoulos et al 2010;Sellebjerg et al 1998;Sorensen et al 2009;Tsang and Macdonell 2011;Warrington and Bostwick, 2006]. Commonly occurring nonpsychiatric AEs for corticotropin injection are similar to those of corticosteroids, as related to stimulation of cortisol release, and include fluid retention and edema, possible change in glucose tolerance, elevated blood pressure, and increased appetite and weight gain.…”

Section: Introductionmentioning

confidence: 91%

Clinical experience with repository corticotropin injection in patients with multiple sclerosis experiencing mood changes with intravenous methylprednisolone: a case series

Murray¹,

Woo²

2015

Ther Adv Neurol Disord

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The elevated prevalence of neuropsychiatric symptoms and disorders among patients with multiple sclerosis (MS) is well recognized, as are potential neuropsychiatric side effects of treatment with corticosteroids. Both methylprednisolone (MP) and repository corticotropin injection (HP Acthar® gel) have demonstrated efficacy in reducing short-term disability after exacerbations of MS. Although historical data are limited, repository corticotropin injection has not generally been associated with detrimental neuropsychiatric effects. We describe six cases of patients with relapsing-remitting MS who had previously experienced detrimental mood changes with MP treatment. Some of these patients had previous histories of mood disorders or other neuropsychiatric symptoms prior to MS diagnosis. All six patients were subsequently treated with repository corticotropin injection for MS exacerbations and each demonstrated improvements in MS symptoms. This clinical experience suggests that repository corticotropin injection should be considered as an alternative for patients who do not tolerate corticosteroids or have difficulties associated with intravenous medication. Furthermore, the rate of neuropsychiatric side effects observed in these patients was low. These observations support repository corticotropin injection as a viable alternative for the treatment of acute exacerbations of MS, particularly in patients who have a history of neuropsychiatric disorders or symptoms either independently or in response to MP treatment. In reviewing both the published data and our own clinical experience regarding potential neuropsychiatric adverse events with treatment for MS exacerbations, we hope to stimulate further research into the potential efficacy and safety of repository corticotropin injection among patients with some form of neuropsychiatric complications that must be considered when establishing a treatment plan for MS.

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Double-blind, randomized, placebo-controlled study of oral, high-dose methylprednisolone in attacks of MS

Abstract: Oral high-dose methylprednisolone is recommended for managing attacks of MS.

Cited by 133 publications

References 9 publications

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

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

Recent progress in the diagnosis and treatment of multiple sclerosis

Clinical experience with repository corticotropin injection in patients with multiple sclerosis experiencing mood changes with intravenous methylprednisolone: a case series

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