Monthly steroid pulses may reduce MS activity

The use of intravenous methylprednisone (IV-MP) is commonplace in treating MS relapses, but monthly use of steroid pulses as an MS maintenance therapy has also been explored on an experimental basis. Initial data shows that monthly IV-MP has potential to be beneficial, but more data on whether it is safe and effective is needed before it can be adopted on a more widespread basis. A new report from Germany (free access) provides some additional support for the use of monthly IV-MP, unfortunately not enough to confirm its efficacy but enough to encourage further investigation.

In this study, nine relapsing-remitting MS subjects were given six monthly 500-mg pulses of IV-MP with a three-day taper, with MRIs taken before each dose. These MRI results were compared with six monthly baseline MRIs taken on each subject prior to the treatment period, as well as with natural history data from comparable subjects provided by the Sylvia Lawry Center. Analysis of the MRIs showed a 43% reduction in Gd-enhancing lesions during the treatment period compared with pre-treatment (the natural history data showed a non-significant reduction). There was also a significant reduction in T2 lesion volume during the treatment phase as well as a reduction in plasma levels of prolactin (an inflammatory molecule). Side-effects were mild, and relapse rate and EDSS appear to have improved slightly over the course of the treatment. The authors conclude that pulsed monthly IV-MP reduces inflammatory activity in relapsing-remitting MS, and recommend more trials of this treatment.