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Related Experiment Videos

Corticosteroids or ACTH for acute exacerbations in multiple sclerosis.

G Filippini1, F Brusaferri, W A Sibley

  • 1Laboratory of Epidemiology, Istituto Nazionale Neurologico C. Besta, Via Celoria, 11, Milan, Italy, 20133. neuroepidemiologia@istituto-besta.it

The Cochrane Database of Systematic Reviews
|October 18, 2000
PubMed
Summary

Corticosteroids like methylprednisolone (MP) effectively reduce acute exacerbations in multiple sclerosis (MS). However, their long-term benefits and optimal use for MS patients require further investigation.

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Area of Science:

  • Neurology
  • Clinical Pharmacology

Background:

  • Corticosteroids are commonly used for multiple sclerosis (MS) exacerbations.
  • Optimal drug, dose, frequency, duration, and route of administration remain unclear.

Purpose of the Study:

  • To review the efficacy and safety of corticosteroids or ACTH in reducing short and long-term morbidity in MS.
  • To examine if corticosteroid effects vary by dose, drug, administration route, or treatment length.

Main Methods:

  • Systematic review of randomized, double-blind, placebo-controlled trials.
  • Searched Cochrane MS Group database (June 1999), handsearching, and personal contacts.
  • Two independent reviewers selected articles, assessed quality, and extracted data; a third reviewer verified.

Main Results:

Related Experiment Videos

  • Six trials (377 participants) analyzed methylprednisolone (MP) and ACTH.
  • MP or ACTH showed a protective effect against worsening within five weeks (OR=0.37, 95% CI 0.24-0.57).
  • No significant difference in efficacy for short vs. long MP treatment duration; no long-term benefits detected after one year. Oral high-dose MP increased gastrointestinal and psychic adverse events; ACTH increased weight gain and edema.

Conclusions:

  • Evidence supports methylprednisolone (MP) for acute MS exacerbations.
  • Insufficient data exist on long-term effects and prevention of new exacerbations.
  • Further studies are needed to assess long-term risks and benefits of corticosteroids in MS.