Management of HAM/TSP: Systematic Review and Consensus-based Recommendations 2019
Abelardo Araujo1, Charles R M Bangham1, Jorge Casseb1
1Laboratory for Clinical Research in Neuroinfections (AA), Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil; Section of Immunology of Infection (CRMB), Department of Infectious Disease, Imperial College London, United Kingdom; Faculdade de Medicina da Universidade de São Paulo/Institute of Tropical Medicine of Sao Paulo (JC), Brazil; Instituto de Medicina Tropical "Alexander von Humboldt" (EG), Universidad Peruana Cayetano Heredia, Lima, Peru; Viral Immunology Section (SJ), National Institutes of Health, Bethesda, MD; Stonewall Medical Centre (FM), Windsor, Australia; Instituto de Infectologia Hospital Emilio Ribas (APO), Sao Paulo University, Sao Paulo, Brazil; Federal University of the State of Rio de Janeiro (UNIRIO)/Federal University of Rio de Janeiro (UFRJ) (MP-S), Brazil; Section of Virology (GPT), Department of Infectious Disease, Imperial College London, United Kingdom; and Department of Rare Diseases Research (YY), Institute of Medical Science, St Marianna University School of Medicine, Kanagawa, Japan.
Purpose Of Review:
To provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)-a rare disease.
Recent Findings:
All 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, based for the most part on observational studies, with only 1 double-masked placebo-controlled randomized trial.
Summary:
There is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5 mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-α as a first-line therapy.
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