Long‐Term Effects of Repeated Cycles of Intrathecal Triamcinolone Acetonide on Spasticity in <scp>MS</scp> Patients

Kamin, F; Abu-Mugheisib, Mazen; Köehler, Wolfgang; Hoffmann, F.; Winkelmann, Alexander; Zettl, Uwe K.

doi:10.1111/cns.12474

Cited by 17 publications

(8 citation statements)

References 27 publications

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“…current data from the DMSG registry), even if no evidence-based studies are available. [47][48][49][50] Recommendation 3: [51][52][53] In addition to preventing acute episodes of the disease, prophylactic therapy may reduce the risk of long-term neurologic deterioration or secondary progression. Due to the slow course of MS, this therapeutic goal cannot be investigated in randomized trials.…”

Section: What Is the Benefit Of Dmt In Patients With Rms Compared With No Treatment/treatment With Another Disease-modifying Drug?mentioning

confidence: 99%

Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper)

Wiendl

Gold

Berger

et al. 2021

Ther Adv Neurol Disord

123

101

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Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).

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Section: What Is the Benefit Of Dmt In Patients With Rms Compared With No Treatment/treatment With Another Disease-modifying Drug?mentioning

confidence: 99%

Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper)

Wiendl

Gold

Berger

et al. 2021

Ther Adv Neurol Disord

123

101

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“…Intrathecal injection of TCA has been demonstrated to significantly improve spasticity, walking distance, fatigue, and disability in MS patients with otherwise therapy-resistant spasticity (10)(11)(12)(13)(14)(15)(16)(17). TCA treatment was also associated with bladder function improvement and increase in quality of life (16). In general, patients with more severe spasticity and higher disability were found to have better clinical outcomes (16).…”

Section: Introductionmentioning

confidence: 99%

“…TCA treatment was also associated with bladder function improvement and increase in quality of life ( 16 ). In general, patients with more severe spasticity and higher disability were found to have better clinical outcomes ( 16 ). Moreover, a negative correlation between the degree of upper spinal cord atrophy and treatment benefits was shown ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a negative correlation between the degree of upper spinal cord atrophy and treatment benefits was shown ( 18 ). Despite the invasiveness of the drug delivery, which in some cases may lead to lumbar puncture headache and back pain, intrathecal TCA applications are usually well-tolerated ( 14 , 16 ). Because there is no long-term improvement of spasticity, repeated cycles of intrathecal TCA injections at intervals of ~3 months are recommended ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Systemic Effects by Intrathecal Administration of Triamcinolone Acetonide in Patients With Multiple Sclerosis

et al. 2020

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In patients suffering from multiple sclerosis (MS), intrathecal injection of triamcinolone acetonide (TCA) has been shown to improve symptoms of spasticity. Although repeated intrathecal injection of TCA has been used in a number of studies in late-stage MS patients with spinal cord involvement, no clinical-chemical data are available on the distribution of TCA in cerebrospinal fluid (CSF) or serum. Moreover, the effects of intrathecal TCA administration on the concentrations of endogenous steroids remain poorly understood. Therefore, we have quantified TCA and selected endogenous steroids in CSF and serum of TCA-treated MS patients suffering from spasticity. Concentrations of steroids were quantified by LC-MS, ELISA, or ECLIA and compared with the blood-brain barrier status, diagnosed with the Reibergram. The concentration of TCA in CSF significantly increased during each treatment cycle up to >5 µg/ml both in male and female patients (p < 0.001). Repeated TCA administration also evoked serum concentrations of TCA up to >30 ng/ml (p < 0.001) and severely depressed serum levels of cortisol and corticosterone (p < 0.001). In addition, concentrations of circulating estrogen were significantly suppressed (p < 0.001). Due to the potent suppressive effects of TCA on steroid hormone concentrations both in the brain and in the periphery, we recommend careful surveillance of adrenal function following repeated intrathecal TCA injections in MS patients.

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“…Regarding autoimmune diseases of the central nervous system (CNS), repeated intrathecal application of the sustained release TRIAM (40–80 mg every other day for one to three injections) is performed since the 1970s in specialized centers in Germany for primary and secondary progressive multiple sclerosis patients and improves, according to observational trials in up to 161 patients, the maximum walking distance, spasticity, and occupational deficits of the upper extremities [3–9]. Three months after repeated application of TRIAM in the cerebrospinal fluid (CSF), an elevated steroid level could still be found.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal triamcinolone acetonide exerts anti-inflammatory effects on Lewis rat experimental autoimmune neuritis and direct anti-oxidative effects on Schwann cells

Pitarokoili

Sgodzai

Grüter

et al. 2019

J Neuroinflammation

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Background Corticosteroids dominate in the treatment of chronic autoimmune neuropathies although long-term use is characterized by devastating side effects. Methods We introduce the intrathecal application of the synthetic steroid triamcinolone (TRIAM) as a novel therapeutic option in experimental autoimmune neuritis in Lewis rats Results After immunization with neuritogenic P2 peptide, we show a dose-dependent therapeutic effect of one intrathecal injection of 0.3 or 0.6 mg/kg TRIAM on clinical and electrophysiological parameters of neuritis with a lower degree of inflammatory infiltrates (T cells and macrophages) and demyelination in the sciatic nerve. In vitro studies in Schwann cell cultures showed an increased expression of IL-1 receptor antagonist and reduced expression of Toll-like receptor 4 after incubation with TRIAM as well as a protective effect of TRIAM against oxidative stress after H 2 O 2 exposure. Conclusion Intrathecal TRIAM application could be a novel immunomodulatory and potentially neuroprotective option for autoimmune neuropathies with a direct effect on Schwann cells.

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Long‐Term Effects of Repeated Cycles of Intrathecal Triamcinolone Acetonide on Spasticity in MS Patients

Cited by 17 publications

References 27 publications

Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper)

Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper)

Systemic Effects by Intrathecal Administration of Triamcinolone Acetonide in Patients With Multiple Sclerosis

Intrathecal triamcinolone acetonide exerts anti-inflammatory effects on Lewis rat experimental autoimmune neuritis and direct anti-oxidative effects on Schwann cells

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