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Methylprednisolone effect on brain volume and enhancing lesions in MS before and during IFNbeta-1b
1Laboratory of Diagnostic Radiology Research, Clinical Center, NIH, Bethesda, MD 20892, USA.
Objective:
To determine the effect of IV methylprednisolone (IVMP) on brain fraction volume (BFV), contrast-enhancing (CE) lesions, and white matter lesion load (WMLL) in patients with relapsing-remitting MS treated for acute exacerbations.
Background:
MRI metrics of MS disease activity are being used as outcome measures in early phase treatment trials, however the short-term effects of IVMP treatment on cerebral atrophy are unknown.
Methods:
Serial monthly MRI were performed in 26 patients enrolled in a baseline vs treatment trial with interferon beta-1b (IFNbeta-1b) who were followed for 3 months before and after IVMP. All 26 patients were evaluated while receiving IFNbeta-1b, and 12 patients were also studied during the baseline stage of the trial (NHx). Acute exacerbations were treated with IVMP (1 g/d) for 3 to 5 days. Precontrast and postcontrast T1-weighted and proton density T2-weighted fast spin-echo images were analyzed.
Results:
Fifty-six acute exacerbations were evaluated. For the 3 months before IVMP, there was no difference in WMLL or BFV compared to month IVMP was administered. There was a significant decrease in BFV at month 1 after IVMP in the IFNbeta-1b and NHx groups. Compared to the month IVMP was administered, there was a difference in the CE lesions for months -3 and -1 prior (p < 0.039) in NHx patients. Following IVMP, CE lesions decreased (p < 0.0004) for months 1, 2, and 3 in both groups, but there was no effect on WMLL.
Conclusions:
BFV and CE lesions were significantly decreased for 1 month (BFV) and 3 months (CE lesions) following IVMP. Therefore, MRI studies should be delayed by probably at least 2 months following IVMP to avoid a possible confounding steroid effect in a clinical trial.
Insights
Intravenous methylprednisolone (IVMP) temporarily reduced brain fraction volume and contrast-enhancing lesions in relapsing-remitting MS patients. White matter lesion load remained unaffected, suggesting MRI timing adjustments are needed post-treatment.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- MRI metrics are crucial for assessing MS disease activity in clinical trials.
- Short-term effects of IVMP on cerebral atrophy in MS patients are not well-documented.
Purpose of the Study:
- To evaluate the impact of IV methylprednisolone (IVMP) on brain fraction volume (BFV), contrast-enhancing (CE) lesions, and white matter lesion load (WMLL).
- To assess these MRI metrics in relapsing-remitting MS patients during acute exacerbations.
Main Methods:
- Serial monthly MRI scans were conducted on 26 relapsing-remitting MS patients over 3 months before and after IVMP treatment.
- Patients received IVMP (1 g/d) for 3-5 days to manage acute exacerbations.
- Precontrast and postcontrast T1-weighted and proton density T2-weighted images were analyzed.
Main Results:
- A significant decrease in BFV was observed one month post-IVMP.
- Contrast-enhancing (CE) lesions significantly decreased for three months following IVMP.
- No significant effect of IVMP was found on white matter lesion load (WMLL).
Conclusions:
- IVMP treatment led to significant short-term reductions in BFV and CE lesions.
- The findings suggest that MRI studies should be timed at least two months after IVMP to avoid confounding steroid effects.
- This timing adjustment is critical for accurate interpretation of MRI data in MS clinical trials.
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