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

I.H. Page Center for Health Outcomes Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Bianca Weinstock-Guttman

Department of Neurology, SUNY University of New York at Buffalo, Buffalo General Hospital, Buffalo, USA

François Béthoux

Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Jar-Chi Lee

Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Gerald Beck

Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Vicki Block

I.H. Page Center for Health Outcomes Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Luca Durelli

Dipartimento di Neuroscienze, Universita di Torino, Torino, Italy

Loredana LaMantia

Instituto Nazionale Neurologico C. Besta, Milan, Italy

David Barnes

Department of Neurology, Atkinson Morley's Hospital, Wimbledon, London, UK

Finn Sellebjerg

Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark

Richard A Rudick

Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

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.

Key Words: multiple sclerosis • methylprednisolone • meta-analysis

Multiple Sclerosis, Vol. 6, No. 4, 267-273 (2000)
DOI: 10.1177/135245850000600408


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