Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis
| Autor: | P Rudge, O Wade-Jones, D A Francis, T Britton, D Barnes, G D Perkin, Rachael A Hughes, Richard W Morris, Peter Brown, H Katifi, Michael Swash, J P Frankel, Simon F. Farmer |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Multiple Sclerosis Time Factors Methyl prednisolone medicine.medical_treatment Administration Oral Methylprednisolone Gastroenterology law.invention Route of administration Disability Evaluation Randomized controlled trial Double-Blind Method Oral administration law Recurrence Internal medicine Humans Medicine Infusions Intravenous Glucocorticoids Expanded Disability Status Scale business.industry Multiple sclerosis General Medicine medicine.disease Surgery Clinical trial Ophthalmology Treatment Outcome Intravenous therapy Ambulatory Female Neurology (clinical) business medicine.drug |
| Popis: | Summary Background An intravenous rather than oral course of methylprednisolone is often prescribed for treating acute relapses in multiple sclerosis (MS) despite the lack of evidence to support this route of administration. Our double-blind placebo-controlled randomised trial was designed to compare the efficacy of commonly used intravenous and oral steroid regimens in promoting recovery from acute relapses in MS. Methods 42 patients with clinically definite relapse in MS received oral, and 38 intravenous, methylprednisolone. Clinical measurements at entry and at 1 week, 4 weeks, 12 weeks, and 24 weeks included Kurtzke's expanded disability status scale (EDSS), Hauser's Ambulatory Index, and an arm-function index. The primary outcome criterion was a difference between the two treatment groups of one or more EDSS grades at 4 weeks. Findings There were no significant differences between the two groups at any stage of the study in any measurement taken: the mean difference in EDSS at 4 weeks (adjusted for baseline level) was 0·07 grades more in those taking oral steroids (95% CI -0·46 to 0·60). The most optimistic outcome for intravenous therapy is an average benefit of less than half a grade improvement on EDSS over oral treatment. Interpretation Since our study did not show any clear advantage of the intravenous regime we conclude that it is preferable to prescribe oral rather than intravenous steroids for acute relapses in MS for reasons of patient convenience, safety, and cost. |
| Databáze: | OpenAIRE |
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