Management of HAM/TSP: Systematic Review and Consensus-based Recommendations 2019

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Therapeutics

Background:

• Human T-lymphotropic virus type 1 (HTLV-1) infection can lead to a chronic neurological condition called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP).
• HAM/TSP is a rare but debilitating disease affecting the spinal cord, causing progressive neurological dysfunction.
• Current therapeutic options for HAM/TSP aim to modify the disease's natural history and manage symptoms.

Purpose of the Study:

• To present an evidence-based review of therapies for improving the natural history of HAM/TSP.
• To provide consensus recommendations for the clinical management of HAM/TSP based on available scientific literature.

Main Methods:

• A systematic review was conducted on 41 articles focusing on the clinical outcomes of disease-modifying therapies for HAM/TSP.
• The review was performed by members of the International Retrovirology Association.
• Evidence quality was assessed, noting a predominance of observational studies and limited randomized controlled trials.

Main Results:

• High-dose pulsed methylprednisolone is recommended for induction therapy in progressive HAM/TSP.
• Low-dose (5 mg) oral prednisolone is recommended as maintenance therapy for progressive HAM/TSP.
• No evidence supports the use of antiretroviral therapy for HAM/TSP.

Conclusions:

• Corticosteroid therapy, specifically methylprednisolone and prednisolone, shows promise in managing progressive HAM/TSP.
• Antiretroviral therapies are not currently recommended due to a lack of supporting evidence.
• Further research is needed to establish the efficacy of other potential treatments like interferon-α.