August 5, 2008

A team of neurologists in Brazil has developed a protocol for PPMS patients involving periodic methylprednisolone (MP) infusions and has reported positive results so far. Their case report describes eleven patients who had a pre-treatment disease duration of 2 to 17 years and EDSS scores of 5 to 7. The treatment regimen included three MP infusions (30 mg/kg or 1.5 grams) the first week, two infusions the second week, once-weekly infusions for the next eight weeks, and then infusions every 10 to 30 days depending on how the person was doing.

At the time of publication, the subjects had been on the MP regimen for 5 to 14 years. EDSS scores had improved in nine subjects, with a decrease ranging from 0.5 to 3 points, and stabilized in the remaining two. Subjects with primarily cerebellar symptoms had greater improvement than those with primarily spinal symptoms. Improvement was gradual. No major side effects were observed.

While this was a small study, and didn't involve a control arm, the results are still interesting, particularly because there are no approved therapies yet for PPMS. The authors recommend establishing a multicenter trial to see whether these results can be replicated in a larger study. Just out of curiosity, are there any MSNews readers who have PPMS and who have tried long-term steroid treatment?

I know I hated the oral prednisone taper (OPT) after IV methylprednisolone (IVMP). Turns out, it may not do anything useful. These researchers' observations suggest that OPT following treatment with IVMP for an MS relapse does not lead to improved neurologic outcome after 12 months compared with treatment with IVMP only.

So bring a printout of this abstract to show your doctor the next time you get steroids and avoid the nasty taper.