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Open Access 01-12-2006 | Research article

Monthly intravenous methylprednisolone in relapsing-remitting multiple sclerosis - reduction of enhancing lesions, T2 lesion volume and plasma prolactin concentrations

Authors: Florian Then Bergh, Tania Kümpfel, Erina Schumann, Ulrike Held, Michaela Schwan, Mirjana Blazevic, Axel Wismüller, Florian Holsboer, Alexander Yassouridis, Manfred Uhr, Frank Weber, Martin Daumer, Claudia Trenkwalder, Dorothee P Auer

Published in: BMC Neurology | Issue 1/2006

Abstract

Background

Intravenous methylprednisolone (IV-MP) is an established treatment for multiple sclerosis (MS) relapses, accompanied by rapid, though transient reduction of gadolinium enhancing (Gd+) lesions on brain MRI. Intermittent IV-MP, alone or with immunomodulators, has been suggested but insufficiently studied as a strategy to prevent relapses.

Methods

In an open, single-cross-over study, nine patients with relapsing-remitting MS (RR-MS) underwent cranial Gd-MRI once monthly for twelve months. From month six on, they received a single i.v.-infusion of 500 mg methylprednisolone (and oral tapering for three days) after the MRI. Primary outcome measure was the mean number of Gd+ lesions during treatment vs. baseline periods; T2 lesion volume and monthly plasma concentrations of cortisol, ACTH and prolactin were secondary outcome measures. Safety was assessed clinically, by routine laboratory and bone mineral density measurements. Soluble immune parameters (sTNF-RI, sTNF-RII, IL1-ra and sVCAM-1) and neuroendocrine tests (ACTH test, combined dexamethasone/CRH test) were additionally analyzed.

Results

Comparing treatment to baseline periods, the number of Gd+ lesions/scan was reduced in eight of the nine patients, by a median of 43.8% (p = 0.013, Wilcoxon). In comparison, a pooled dataset of 83 untreated RR-MS patients from several studies, selected by the same clinical and MRI criteria, showed a non-significant decrease by a median of 14% (p = 0.32). T2 lesion volume decreased by 21% during treatment (p = 0.001). Monthly plasma prolactin showed a parallel decline (p = 0.027), with significant cross-correlation with the number of Gd+ lesions. Other hormones and immune system variables were unchanged, as were ACTH test and dexamethasone-CRH test. Treatment was well tolerated; routine laboratory and bone mineral density were unchanged.

Conclusion

Monthly IV-MP reduces inflammatory activity and T2 lesion volume in RR-MS.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/6/19/prepub

Title: Monthly intravenous methylprednisolone in relapsing-remitting multiple sclerosis - reduction of enhancing lesions, T2 lesion volume and plasma prolactin concentrations
Authors: Florian Then Bergh
Tania Kümpfel
Erina Schumann
Ulrike Held
Michaela Schwan
Mirjana Blazevic
Axel Wismüller
Florian Holsboer
Alexander Yassouridis
Manfred Uhr
Frank Weber
Martin Daumer
Claudia Trenkwalder
Dorothee P Auer
Publication date: 01-12-2006
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2006
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/1471-2377-6-19

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Monthly intravenous methylprednisolone in relapsing-remitting multiple sclerosis - reduction of enhancing lesions, T2 lesion volume and plasma prolactin concentrations

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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