Clinical impact of high-dose intravenous methylprednisolone for ten days in relapses of multiple sclerosis: "Treatment of relapses in multiple sclerosis"

Abstract

Background: Glucocorticoid treatment is recommended as the first-line treatment of MS relapses, however there is still no clear evidence supporting an optimum therapeutic regime. The high dose (HD) consisted of at least 500 mg/day, but the total dose of intravenous MP administered and the regimen varied among studies. The aim of this study was to assess the improvement following a standard regime of IVMP (1 g/day MP given for 10 days, without tapering) for MS relapses. A second objective was to search baseline predictors of outcome. Method: Consecutive treatments with IVMP for ten days (1 g/day, single dose in 150cc. saline, over 40 min) administered at our Neurology clinic for an episode of acute neurological deterioration in 44 patients (55 relapses) diagnosed with RR MS were recruited retrospectively. Results: Attack severity was mild in three, moderate in 28 and severe in 24 relapses. Significant improvement (? 1.0 EDSS point) occurred in 81 % of attacks at one month. The rate of improvement at ten days was 83.6%, and 85.5% at six months. There was no difference in means of latency to treatment between the patients that responded well to therapy and responded poor, at the first month. However response to therapy was higher at the sixth month in patients with latency to treatment shorter than fifteen days (68.4%, 94.4%). Conclusions: In conclusion the results of our retrospectively designed clinical study support that HD MP, 1 g/day for ten days administered IV can accelerate the recovery from MS relapses. This regimen with proper early timing for starting therapy might determine the optimum benefit. © Universitätsverlag Ulm GmbH 2009