A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations

Abstract

Despite recent advances in multiple sclerosis treatment, patients experience relapses for which standard treatment remains glucocorticosteroids (GCS). However, there is limited information comparing doses or routes of administration for different GCS types or the benefit of GCS compared to natural recovery. Currently, high dose (HD) methylprednisolone (MP) is the preferred therapy. We conducted meta-analyses of published studies assessing MP at different doses and in comparison to other steroid products or no treatment. Relevant studies were identified through predetermined processes and five articles met the inclusion criteria. Three studies compared HD MP to placebo; two studies compared the effect of HD MP and low dose (LD) MP; only one accepted report compared HD MP to another GCS. This report could not be included in a meta-analysis. The meta-analysis of HD MP vs placebo studies indicated a mean treatment difference of 0.76 in Expanded Disability Status Score (EDSS) changes from baseline. The meta-analysis of HD and LD MP demonstrated no difference in EDSS change. Despite these rather obvious findings, these meta-analyses have been valuable in identifying further research questions. We recommend studies to determine optimum benefit related to dosage, timing for starting therapy and the most appropriate GCS type. Given the advances in MS therapeutics, these studies will have to include patients on additional disease modifying therapy.

Keywords

multiple sclerosis methylprednisolone meta-analysis

Get full access to this article

View all access options for this article.

References

Anderson DW et al. (1992) Revised estimates of the prevalence of multiple sclerosis in the United States . Ann Neurol 31: 333-336 .

Weinshenker BG et al. (1989) The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability . Brain 112: 133-146 .

[published erratum appears in Ann Neurol 1996 Sep 40(3): 480-480 ].

The IFNB MS study group and the University of British Columbia MS/MRI Analysis Group . (1995) Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial . Neurology 45: 1277-1285 .

Myers LW. (1992) Treatment of multiple sclerosis with ACTH and corticosteroids. In: Rudick RA , Goodkin DE (eds). Treatment of multiple sclerosis: Trial design, results and future perspectives. London: Springer-Verlag , pp. 135-156.

Lussier ML , Hafler DAWHL. (1990) In: Cook S , (ed.). Handbook of multiple sclerosis. New York: Marcel Dekker , pp. 317-326.

Montalban X. (1997) In: Thompson AJ , Polman C , Hohlfeld R (eds.). Multiple sclerosis: clinical challenges and controversies. London: Martin Dunitz , pp. 155-167.

Kurtzke J. (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) . Neurology 33: 1444-1452 .

Lang T , Secic M. (1997) How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers. Philadelphia, Pennsylvania: American College of Physicians .

10.

Laird NM , Mosteller F. (1990) Some statistical methods for combining experimental results . International Journal of Technology Assessment in Health Care 6: 5-30 .

11.

DerSimonian R , Laird N. (1986) Meta-analysis in clinical trials . Controlled Clinical Trials 7: 177-188 .

12.

Durelli L et al. (1986) High-dose intravenous methylprednisolone in the treatment of multiple sclerosis: clinical-immunologic correlations . Neurology 36: 238-243 .

13.

Milligan NM , Newcombe R , Compston DA. (1987) A double-blind controlled trial of high dose methylprednisolone in patients with multiple sclerosis: 1. Clinical effects . J Neurol Neurosurg Psychiatry 50: 511-516 .

14.

Sellebjerg F , Frederiksen JL , Nielsen PM , Oelsen J. (1998) Double-blind, randomized, placebo-controlled study of oral, high-dose methylprednisolone in attacks of MS . Neurology 51: 529-534 .

15.

Barnes D et al. (1997) Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis [see comments] . Lancet 349: 902-906 .

16.

La Mantia L et al. (1994) Double-blind trial of dexamethasone versus methylprednisolone in multiple sclerosis acute relapses . Euro Neurol 34: 199-203 .

17.

Milanese C et al. (1989) Double-blind randomized trial of ACTH versus dexamethasone versus methylpredniso-lone in multiple sclerosis bouts. Clinical, cerebrospinal fluid and neurophysiological results . Euro Neurol 29: 10-14 .

18.

Beck RW et al. (1992) A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group [see comments] . New England Journal of Medicine 326: 581-588 .

19.

Alam SM , Kyriakides T , Lawden M , Newman PK. (1993) Methylprednisolone in multiple sclerosis: a comparison of oral with intravenous therapy at equivalent high dose . J Neurol Neurosurg Psychiatry 56: 1219-1220 .

20.

Thompson AJ et al. (1989) Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS . Neurology 39: 969-971 .

21.

Sellebjerg F , Nielsen HS , Frederiksen JL , Oelsen J. (1999) A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis . Neurology 52: 1479-1484 .