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ALS Untangled

ALSUntangled #65: glucocorticoid corticosteroids

Jill Ann Goslinga1 Neurology Department, University of California San Francisco, San Francisco, CA, USACorrespondence[email protected]

Mark Terrelonge Jr.1 Neurology Department, University of California San Francisco, San Francisco, CA, USA

Richard Bedlack2 Neurology Department, Duke University, Durham, NC, USA

Paul Barkhaus3 Neurology Department, Medical College of Wisconsin, Milwaukee, WI, USA

Benjamin Barnes4 Neurology Department, Augusta University Medical College of Georgia, Augusta, GA, USA

Tulio Bertorini5 Neurology Department, University of Tennessee Health Science Center, Memphis, TN, USA

Mark Bromberg6 Neurology Department, University of Utah Health, Salt Lake City, UT, USA

Gregory Carter7 Physical Medicine and Rehabilitation, Saint Luke's Rehabilitation Institute, Spokane, WA, USA

Amy Chen8 Neurology Department, Medical University of South Carolina, Charleston, SC, USA

Jesse Crayle9 Neurology Department, Washington University, St. Louis, MO, USA

Mazen Dimachkie10 Neurology Department, University of Kansas Health System, Kansas City, KS, USA

Leanne Jiang11 Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Nedlands, WA, AUS

https://orcid.org/0000-0002-1729-9729

Gleb Levitsky12 Real Health Clinic, Moscow, Russian Federation

Isaac Lund13 Green Hope High School, Cary, NC, USA

Sarah Martin14 Physical Therapy Department, Duke University, Durham, NC, USA

Christopher Mcdermott15 Institute for Translational Neuroscience, The University of Sheffield, Sheffield, SY, UK

https://orcid.org/0000-0002-1269-9053

Gary Pattee16 Neurology Department, University of Nebraska Medical Center, Lincoln, NE, USA

Kaitlyn Pierce17 Undergraduate, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Dylan Ratner18 Longmeadow High School, Longmeadow, MA, USA

Lenka Slachtova19 Biology and Medical Genetics, Univerzita Karlova Biologicka Sekce, and

Yuyao Sun2 Neurology Department, Duke University, Durham, NC, USA

Paul Wicks20 Independent Contractor

https://orcid.org/0000-0002-2293-9284

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Abstract

ALSUntangled reviews alternative and off-label treatments for people with amyotrophic lateral sclerosis (PALS). Here we review glucocorticoids. Neuroinflammation plays a prominent role in amyotrophic lateral sclerosis (ALS) pathogenesis, so some hypothesize that glucocorticoids might be an effective ALS therapy through their immunosuppressive effects. In this paper, we review the available evidence for glucocorticoids in ALS, including one pre-clinical study with a genetic mouse model of ALS, nine case reports (ranging from 1 to 26 patients each), and four clinical trials. We also review the possible side effects (including steroid myopathy) and the costs of therapy. We graded the level of evidence as follows: Mechanism, D; Pre-Clinical, F; Cases, B; Trials, F; Risks, C. Our review of the current evidence concludes that glucocorticoids do not offer clinical benefit in ALS and confer serious risks. Thus, ALSUntangled does not recommend glucocorticoids as a treatment for ALS.

Keywords:

Declaration of interest

Richard Bedlack has research support from ALSA, Orion, MediciNova, and the Healey Center, and consulting support from AB Science, Alexion, ALSA, Amylyx, Biogen, Black Swan, Brainstorm Cell, Corcept, Cytokinetics, GenieUs, Guidepoint, ITF Pharma, Mallinkrodt, New Biotic, Orphazyme, Shinkei, and Woolsey Pharma. Other authors have no reported disclosures.

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ALSUntangled #65: glucocorticoid corticosteroids

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ALSUntangled #65: glucocorticoid corticosteroids

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