Efetividade da metilprednisolona na fase aguda do trauma raquimedular: revisão sistemática dos ensaios clínicos randomizados

Abstract

Steroid therapy has been tested as a neuronal protector in spinal cord injury. Multicenter studies evaluating the efficacy of methylprednisolone (MP) in posttraumatic neurological recovery have shown promising results (NASCIS). However, several critical studies related to NASCIS results have been published. Objective. To review the literature concerning the use of methylprednisolone compared with placebo. MethOds. This analysis added the mean improvement obtained by groups of patients using MP and placebo (PL) to their mean scores at baseline, before treatment, resulting in the final neurological outcome for both groups. Results. The motor score in the MP group was only 2.5 points higher than in the PL group after a one-year follow-up. In neurologically intact individuals, the motor score is 70 points. Improvement in sensory scores was also discrete (1.1 and 1.7 points for pinprick and light touch sensation, respectively). A high rate of complications was observed in a group of patients aged about 60 years who used MP. cOnclusiOn. Differences in the clinical magnitude of the benefits obtained (not confirmed by other studies) with the use of MP and PL are not significant against the potential complications when using this medication.

Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry

“…Bracken and Botelho and colleagues have each reported on meta-analyses that evaluate the effect of methylprednisolone against placebo in patients with TSCIs, but the conclusions from these studies are conflicting and each is limited by poor methodological credibility. 15 , 59 Neither ensured that the selection of studies was reproducible, neither explored possible explanations for between-studies differences in results, and neither study addressed the overall quality of the evidence or confidence in the pooled estimates. 58 According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach, confidence in pooled effect estimates depends on study design, risk of bias, imprecision, inconsistency, indirectness, publication bias, and other factors.…”

Therapeutic approaches for spinal cord injury

“…In addition, studies reviewing the methodologies used in NASCIS and other research projects reported the deleterious side effects of massive doses of corticosteroids. These side effects have led many centers to avoid routinely using corticoids, particularly methylprednisolone (53), for SCI lesions (52). …”

Thoracolumbar spine trauma: Evaluation and surgical decision-making

“…[25] However, many methodological biases were pointed later by other authors, suggesting that the benefits of corticosteroids were minimal when compared to the potential catastrophic complications. [262728] Furthermore, the studies included both cervical and thoracolumbar spinal cord injuries without independent data reporting. In this context, the use of methylprednisolone is not accepted as a standard therapy in many centers.…”