Corticosteroids or acth for acute exacerbations in multiple sclerosis

G. Filippini, F. Brusaferri, A. Citterio, G. Ciucci, R. Midgar, W. A. Sibley, L. Candelise

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. To examine the efficacy of corticosteroids in reducing the short- and long-term morbidity from multiple sclerosis (MS). Primary outcomes were: a) no improvement or worsening in disability grade on the Expanded Disability Status Scale (EDSS) or an equivalent score within a period no longer than 12 weeks from randomization; (b) proportion of patients who relapsed at 6 months, 1 year, 2 years and 3 years from randomization; and (c) proportion of patients who had disability progression from 12 weeks until the end of the follow-up period. Methods. A search strategy developed for the Cochrane MS Group completed with handsearching and personal contacts with trialists and pharmaceutical companies were used. All unconfounded, randomized, controlled trials comparing corticosteroids or ACTH to placebo in patients with MS, treated for acute exacerbation, without any age or severity restrictions, were evaluated. Two authors independently assessed the trials' quality and extracted data. A third author checked them. Data analysis was performed using Review Manager 4.0.4. Results. Six trials contributed to this review; a total of 377 participants (199 treatment, 178 placebo) were randomized. The drugs analyzed were methylprednisolone (MP) (four trials, 140 patients) and ACTH (two trials, 237 patients). One trial of intramuscular ACTH accounted for 197 of the total 377 subjects studied (52%). Overall, MP or ACTH showed a protective effect against the disease getting worse or stable within 5 weeks from randomization (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24-0.57) with some, but nonsignificantly greater effect for MP and intravenous administration. Short (5 days) or long (15 days tapering) duration of treatment with MP did not show any significant difference. In one study (total n=51) no difference between steroids and controls in the pre- vention of new exacerbations or improvement in long-term disability was detected. No data are available beyond 1 year of follow-up to indicate whether steroids have any effect on long-term progression. We also found some suggestion that psychic disorders may develop more often in the intravenous MP group (11/50, 22%) than in the control group (5/44, 11.4%), but results did not reach conventional statistical significance (OR 2.37, 95% CI 0.77-7.23). Conclusions. We found evidence favoring corticosteroids for acute exacerbation in MS patients. The possibility of psychic disorders associated with the treatment cannot be confirmed nor ruled out by this meta-analysis. Data are too sparse to provide reliable estimates of effect of corticosteroids on other important outcomes, including prevention of new exacerbations and long-term disability. Studies assessing the long-term benefits and adverse effects of corticosteroids in MS patients are urgently needed.

Original languageEnglish
JournalNeurological Sciences
Volume21
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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