Predictors for Therapy Response to Intrathecal Corticosteroid Therapy in Multiple Sclerosis

Area of Science:

• Neurology
• Immunology
• Clinical Medicine

Background:

• Multiple Sclerosis (MS) is a heterogeneous autoimmune disease causing progressive disability.
• Intrathecal corticosteroid therapy (ICT) is a symptomatic treatment for MS, reducing spasticity and improving quality of life.
• Predicting response to ICT is crucial for optimizing patient management.

Purpose of the Study:

• To investigate cerebrospinal fluid (CSF) parameters as predictors of response to ICT in MS patients.
• To identify clinical predictors for successful ICT outcomes.
• To analyze the long-term clinical progress of patients undergoing ICT.

Main Methods:

• Retrospective analysis of 811 CSF samples from 354 MS patients over 12 years.
• Patients receiving ICT were categorized into 'improving' or 'active' groups based on EDSS progression.
• Comparison with ICT-naïve control groups and analysis of clinical data including disease onset, EDSS, CSF cell counts, and total protein.

Main Results:

• Clinical factors significantly influenced ICT response. Early disease onset (<35 years) and higher baseline EDSS (>6) predicted a higher likelihood of improvement (OR=2.43 and OR=2.06, respectively).
• Patients responding to ICT showed significantly lower CSF cell counts (6.68 ± 1.37 μl) and total protein (412 ± 18.25 mg/l) compared to non-responders (p < 0.05).
• Patients in the 'improving' group reached an EDSS of 6 significantly later than those in the 'active' group (39.8% vs. 67.8% after 13 years).

Conclusions:

• Disease onset, baseline EDSS, CSF cell count, and total protein levels are potential predictive markers for ICT response in MS.
• ICT was well-tolerated in this cohort, with no severe side effects observed.
• These findings can aid in patient selection and management strategies for ICT in Multiple Sclerosis.