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Mult Scler. 2016 Sep;22(10):1337-48. doi: 10.1177/1352458515617248. Epub 2015 Nov 12.

Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica.

Author information

1
Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
2
Sapporo Neurology Clinic, Sapporo, Japan.
3
Department of Neurology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
4
Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan.
5
Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan.
6
Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan.
7
Department of Neurology, Kinki University School of Medicine, Osaka, Japan.
8
Department of Clinical Research, NHO Hokkaido Medical Center, Sapporo, Japan.
9
Department of Neurology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
10
Department of Neurology, Saitama Medical University, Saitama, Japan.
11
Multiple Sclerosis Center, NHO Utano National Hospital, Kyoto, Japan.
12
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
13
Department of Neurology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
14
Department of Neurology, National Defense Medical College, Tokorozawa, Japan.
15
Department of Neurology, Kanazawa Medical University, Kanazawa, Japan.
16
Department of Neurology, Osaka University, Osaka, Japan.
17
Department of Neurology, Graduate School of Medicine, Ehime University, Matsuyama, Japan.
18
Department of Neurology, Iwate Medical University, Morioka, Japan.
19
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.
20
Department of Neurology, NHO Nagasaki Kawatana Medical Center, Kawatana, Japan.
21
Clinical Statistics, Pfizer Japan Inc., Tokyo, Japan.
22
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
23
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan kira@neuro.med.kyushu-u.ac.jp.

Abstract

BACKGROUND:

No large-scale studies have compared the efficacy of intravenous methylprednisolone pulse therapy (IVMP) for multiple sclerosis (MS) and neuromyelitis optica (NMO).

OBJECTIVE:

To explain differences in treatment responses of MS and NMO patients to IVMP.

METHODS:

Changes in neurological symptoms/signs and Expanded Disability Status Scale (EDSS) scores before and within 1 week of IVMP completion were obtained in 2010 at 28 institutions, and retrospectively collated from 271 MS (478 courses) and 73 NMO (118 courses) cases.

RESULTS:

In MS patients, decreased EDSS score was significant after the first (-0.8 ± 0.9), second (-0.7 ± 0.9), and third (-0.7 ± 0.8) courses (p < 0.05), but not after the fourth (-0.3 ± 0.7) and fifth (-0.5 ± 0.6). However, decreased EDSS score was only significant after the first course (-0.5 ± 1.5, p < 0.05) in NMO patients. EDSS score was significantly decreased in MS compared with NMO patients at the first course (p < 0.05), but not thereafter. Model analysis for EDSS score improvement at the first course, adjusting for covariates, showed significantly greater decreases in MS compared with NMO patients (p < 0.05).

CONCLUSION:

IVMP is effective in MS from the first to third courses, and in NMO at the first course. Additionally, IVMP is more efficacious in MS than NMO patients, even at the first course.

KEYWORDS:

Multiple sclerosis; corticosteroids; methylprednisolone; neuromyelitis optica; pulse therapy

PMID:
26564994
DOI:
10.1177/1352458515617248
[Indexed for MEDLINE]

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