Intravenous methylprednisolone for multiple sclerosis in relapse.

Abstract

A randomised comparison is made between methylprednisolone, 1 g intravenously daily for 7 days, and a standard ACTH regime for the treatment of multiple sclerosis in acute relapse. It is found that methylprednisolone produces a more rapid clinical improvement than ACTH but confers no longer term benefit when the two treatments are compared at 3 months. It is proposed that intravenous methylprednisolone does have a role to play in the management of a patient with an acute relapse of multiple sclerosis. In the earlier stages of multiple sclerosis morbidity may be reduced by the judicious use of a short course of steroids during an acute relapse. Both intramuscular ACTH' and oral prednisolone2 have been shown to decrease the duration of an exacerbation of multiple sclerosis but no long term benefit follows and more prolonged steroid treatment is usually ineffective.3 Recent reports4-6 have suggested that pulsed therapy with large doses of methylprednisolone may be effective in relapsing multiple sclerosis. This communication presents a randomised comparison of methylprednisolone with a standard ACTH regime. Methods Patients with clinically definite multiple sclerosis according to the criteria of McAlpine' who presented to the Department of Neurology at Middlesbrough General Hospital in acute relapse were considered for inclusion in the trial. Relapse was defined as a symptomatic deterioration within the previous 4 weeks and no patient was improving spontaneously on entry. Each patient gave fully informed consent before randomisation to receive either intravenous methylprednisolone 1 g by slow injection daily for 7 days,

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

“…Additionally, daily administration of 500-1000 mg of MP increases serum steroid peak levels 5-10 times more compared with ACTH administration (54). Despite these, positive effects equivalent to MP have been reported with ACTH use in relapse treatment (59,60,61). This effect is attributed to the direct anti-inflammatory and immunomodulatory effects of ACTH through melanocortin receptors.…”

Clinical and evoked potential changes in acute transverse myelitis following methyl prednisolone

“…The role of MPS in multiple sclerosis is well documented and its bene®cial role in ATM has also been reported. 4,5,12,13 More pronounced clinical improvement at 3 months compared to 7 days after MPS therapy may be due to a natural process of improvement although a delayed bene®cial e ect of MPS cannot be ruled out. The answer to this question requires a double blind controlled trial.…”

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

“…Of four trials that examined short-term treatment of patients with MS with an ACTH analogue compared with either placebo [Rose et al 1970] or IV MP [Abbruzzese et al 1983;Barnes et al 1985;Thompson et al 1989], few provided data pertinent to mood changes. A large study of 197 MS patients (n = 103, ACTH; n = 94, placebo) reported some evidence, albeit limited, of improvement in mood, but without further details about the types of mood changes [Rose et al 1970].…”

“…Finally, two of the studies of patients receiving either ACTH or MP did not provide information regarding mood changes in either group [Abbruzzese et al 1983;Barnes et al 1985]. …”