Follow-up study of MS patients treated with high-dose intravenous methylprednisolone

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Abstract
In a longitudinal prospective study, we followed 56 patients (17 men, 29 women) with definite multiple sclerosis (MS), who were treated with high‐dose intravenous methylprednisolone (IVMP), 10 consecutive days with 1000 mg IVMP daily. Mean follow‐up period after entry was 2.6 years (range 1.7–3.5 yrs.). All patients were treated because of a symptomatic deterioration. Independent of the disease courses (RR‐relapsing remitting/CP‐chronic progressive/CP + RR‐ mixed course), 65% of the 46 MS patients (30/46) showed a clinical improvement after the first IVMP course, expressed by a decrease in the EDSS rating (1.0 point or more). During the follow‐up period 59 additional IVMP courses (range 0–5 courses per patient) were given; 8 patients were treated with a combination of cyclophosphamide and prednisone, because of strong continuous progression. During the follow‐up period 19 patients (41%) showed an increase in the EDSS‐rating (1.0 point or more) compared with the EDSS level just after the first IVMP; 22 patients (48%) had no changes in the EDSS‐rating, and 5 patients (11%) showed a clinical improvement (decrease of 1.0 point or more). In the relapsing MS patients (RR and CP + RR, n = 38) mean relapse rate/patient/year prior to the first IVMP was 2.6, which significantly (p< 0.0001) decreased to 0.8 during the follow‐up period. Statistically no significant difference was found between baseline EDSS and EDSS ratings after the follow‐up period in relapsing MS patients. In the CP MS patients clinical decline (increase of 1.0 point or more on the EDSS) during the follow‐up period was most prominent: 11 (58%) of the CP MS patients showed an increase of the EDSS‐rating, followed by 3 (37.5%) of the CP + RR MS group. Clinical deterioration was lowest for the RR MS patients (26%; 5/19). After the follow‐up period a significant (p< 0.05) increase in the mean EDSS was noted compared with baseline EDSS (3.8 to 4.6) in chronic progressive MS (CP and CP + RR). The cerebrospinal fluid (CSF) variables (CSF mononuclear cells, CSF myelin basic protein (MBP), number of oligoclonal bands on iso‐electric focusing (IEF), IgG index and intrathecal IgG synthesis) decreased significantly after the initial IVMP. After the follow‐up period, all variables showed a persistent decrease compared with the levels prior to the first IVMP, both in patients receiving a single as well as multiple courses of IVMP. Our study suggest, that (repeated) IVMP reduces the relapse rate in relapsing MS patients, although development of disability is not prevented in RR disease. In chronic progressive MS (repeated) IVMP seems not decrease the clinical deterioration in comparison with the natural course. Prolonged effects are noted in the CSF of MS patients treated with IVMP, 1.6 years after the initial treatment.