Oral administration of methylprednisolone powder for intravenous injection dissolved in water to treat MS and NMOSD relapses during COVID-19 pandemic in a real-world setting

Abstract

Background: Upon the COVID-19 pandemic emergence, safety concerns and logistic drawbacks stimulated the search for alternatives to pulse therapy at infusion centres to treat multiple sclerosis relapses. Objective: To describe our experience treating multiple sclerosis relapses with a dilute injectable methylprednisolone powder orally administered, in a safe home-based environment and with totally virtual assessment and follow up via telemedicine. Methods: Descriptive observational, retrospective, single-centre, open label, study in the real-world setting. Results: Between August 2020 and March 2021, ten multiple sclerosis patients and one neuromyelitis optica spectrum disease patient, regularly assisted at our multiple sclerosis centre in Argentina, experienced twelve disease relapses (nine moderate/severe relapses and three mild relapses) and were treated with the oral dilute of injectable methylprednisolone powder pulses with good efficacy as well as adequate tolerance and safety profile. Conclusions:The oral pulse therapy based on the methylprednisolone powder dilution we describe is simple and comfortable to administer and can be an option in countries like Argentina, where the oral methylprednisolone formulation is not marketed. In these pandemic times, a home based and virtually monitored pulse therapy could represent a safe and effective alternative to manage relapses while minimizing the patient's risk of exposure to SARS-CoV-2.

Argentinean consensus recommendations for the use of telemedicine in clinical practice in adult people with multiple sclerosis

“…Previous studies have shown the usefulness of telemedicine for the identification of relapses during the beginning of the COVID-19 pandemic [ 52 ]. On the other hand, recommendations for the identification of relapses using telemedicine were also published during the pandemic [ 14 , 53 , 54 ]. A recent Argentinean publication describes the approach of the whole relapse process with fully telehealth management, from its diagnosis (onset) through the indication of oral methylprednisolone pulse at home, with close monitoring and follow-up of the patients until its resolution or stabilization.…”

“…A recent Argentinean publication describes the approach of the whole relapse process with fully telehealth management, from its diagnosis (onset) through the indication of oral methylprednisolone pulse at home, with close monitoring and follow-up of the patients until its resolution or stabilization. The results showed this was a safe and effective mean to treat MS and NMOSD relapses [ 54 ]. Therefore, if some elements are relatively easy to assess remotely (e.g., timing of symptoms, history of concomitant fever, symptoms of infection, among others) and neurological abnormalities could be detected as suggested above (Tele-EDSS, webcam-based EDSS, or PDDS), a relapse diagnosis could be made using telemedicine.…”

“…In doubtful cases or when the patients cannot clearly refer to their symptoms, face-to-face evaluation is strongly recommended. Regarding the treatment of a relapse, corticosteroids are often the first treatment option for MS relapses [ 54 ]. Several clinical trials and two meta-analyses provide evidence that high-dose corticosteroids hasten neurological recovery and improve EDSS after MS relapse [ 55 , 56 ].…”

High Targeting Specificity toward Pulmonary Inflammation Using Mesenchymal Stem Cell‐Hybrid Nanovehicle for an Efficient Inflammation Intervention

“…[8,11] MP has been proven as a powerful agent to inhibit inflammation by inhibiting the production of proinflammation factors (for example, TNF-𝛼 and IL-6), thereby reducing cytokine storm. [12,13] Also, MP had ability to relieve the cell growth suppression in alveolar epithelial cells. [14] In the treatment of lung inflammation, MP is usually systemic administrated for a high absorption and rapid inflammatory suppression, [15,16] it can also be oral administrated in some cases.…”

Oral pulsed high-dose dexamethasone therapy for rheumatic diseases: An alternative safe and effective scheme

“…Oral pulse therapy (OPT) has been commonly used in dermatology for alopecia areata, vitiligo, and alopecia Universalis, among others, with good results [ 2 , 3 ]; in neurology, it has been used to treat chronic inflammatory demyelinating polyneuropathy [ 4 ]. An exciting work by Luetic et al [ 5 ], from Argentina, that, in times of Covid, with the impossibility of performing conventional pulse therapy, OPT has been used to treat multiple sclerosis with good efficacy. In hematology, this is one of the first-line treatments for idiopathic thrombocytopenic purpura [ 6 ].…”