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[Randomized controlled trial of high-dose peroral methylprednisolone in attacks of multiple sclerosis]
F Sellebjerg1, J L Frederiksen, P M Nielsen
1Neurologisk afdeling, Amtssygehuset i Glostrup.
Abstract:
The efficacy of glucocorticoid treatment in multiple sclerosis (MS) is uncertain. We assessed the effect of oral high-dose methylprednisolone in attacks of MS. Twenty-five patients with an attack of MS with a duration of less than four weeks were randomized to placebo, 26 patients received oral methylprednisolone (500 mg once daily for five days with a 10 days tapering period). Scripps Neurological rating scale scores differed significantly in methylprednisolone and placebo-treated patients the first three weeks (p = 0.005) and after eight weeks (p = 0.0007). Subjective symptom assessment on a visual analogue scale the first three weeks (p = 0.02) and the answers to an efficacy questionnaire administered after eight weeks (p = 0.05) also favoured a beneficial effect of methylprednisolone treatment. The risk of a new attack of MS was not influenced by the treatment at short-term follow up. No serious adverse events were seen. Oral high-dose methylprednisolone is recommended for treatment of attacks of MS.
Insights
Oral high-dose methylprednisolone effectively treats multiple sclerosis (MS) attacks, improving neurological scores and symptoms. This treatment is recommended for MS relapses, with no serious adverse events observed.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- The effectiveness of glucocorticoid therapy in managing multiple sclerosis (MS) attacks remains unclear.
- High-dose methylprednisolone is a potential treatment option for acute MS exacerbations.
Purpose of the Study:
- To evaluate the efficacy of oral high-dose methylprednisolone in patients experiencing an MS attack.
- To compare the effects of methylprednisolone versus placebo on neurological and subjective MS symptoms.
Main Methods:
- A randomized controlled trial involving 51 patients with recent MS attacks (duration < 4 weeks).
- Participants were assigned to receive either oral methylprednisolone (500 mg daily for 5 days with a 10-day taper) or a placebo.
- Outcomes assessed included the Scripps Neurological Rating Scale, a visual analogue scale for subjective symptoms, and an efficacy questionnaire.
Main Results:
- Methylprednisolone treatment resulted in significant improvements in Scripps Neurological rating scale scores at 3 weeks (p = 0.005) and 8 weeks (p = 0.0007) compared to placebo.
- Subjective symptom assessments also favored methylprednisolone, showing significant benefits at 3 weeks (p = 0.02) and 8 weeks (p = 0.05).
- The study found no significant short-term influence of methylprednisolone on the risk of new MS attacks.
Conclusions:
- Oral high-dose methylprednisolone demonstrates significant efficacy in treating acute attacks of multiple sclerosis.
- The treatment improves both objective neurological deficits and subjective patient-reported symptoms.
- Based on these findings, oral high-dose methylprednisolone is recommended for the management of MS attacks.