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Published on: March 26, 2015
Modified total lymphoid irradiation and low dose corticosteroids in progressive multiple sclerosis
S D Cook1, C Devereux, R Troiano
1Department of Neurosciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark 07103, USA.
Modified total lymphoid irradiation (TLI) with low-dose prednisone significantly slowed disability progression in multiple sclerosis (MS) patients. TLI therapy reduced relapses and new brain lesions, demonstrating its efficacy in progressive MS.
Area of Science:
- Immunology
- Neurology
- Radiotherapy
Background:
- Multiple sclerosis (MS) is a progressive neurological disease.
- Current treatments for progressive MS have limited efficacy.
- Total lymphoid irradiation (TLI) is an immunosuppressive therapy.
Purpose of the Study:
- To evaluate the efficacy and safety of modified total lymphoid irradiation (TLI) plus low-dose prednisone (TLI-LDP) versus sham TLI plus prednisone in progressive MS.
- To assess the impact of TLI-LDP on disability progression, relapse rates, and MRI lesion activity.
Main Methods:
- Double-blind, prospective, randomized trial with 46 progressive MS patients.
- Comparison between TLI-LDP group and sham TLI-LDP group.
- Primary endpoint: sustained one-point decline in Expanded Disability Status Scale (EDSS) analyzed by Kaplan-Meier survival analysis.
Main Results:
- Significantly fewer TLI patients experienced a sustained one-point EDSS decline (P<0.005).
- TLI treatment reduced the risk of relapse by 54% (P<0.05).
- TLI-LDP patients showed fewer gadolinium-enhancing and new T2 lesions (P=0.018) and decreased lymphocytes post-treatment.
Conclusions:
- Modified TLI plus low-dose prednisone is effective in slowing disability progression in progressive MS.
- TLI-LDP demonstrates significant benefits in reducing relapses and MRI lesion activity.
- TLI therapy is generally well-tolerated with mild side effects, supporting its role in managing progressive MS.
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