Re-examining the Effects of high-dose Intravenous Methylprednisolone for Secondary Progressive Multiple Sclerosis

Abstract

Background/objective: Intravenous methylprednisolone (IVMP) is previously given to secondary progressive multiple sclerosis (SPMS) patients. This study aimed to re-examine the effects of IVMP in SPMS. Materials & methods: Major electronic databases were searched for randomized controlled trials. Results: Four randomized controlled trials were included. IVMP may be inferior to mitoxantrone (MTX) in terms of expanded disability status scale (EDSS) improvement. There was no significant difference in terms of EDSS reduction and magnetic resonance imaging (MRI) plaque reduction when IVMP + MTX were compared with MTX. There is no significant difference between IVMP and cyclophosphamide based on EDSS progression and relapse reduction. Conclusion: IVMP should not be routinely used as treatment for SPMS and is not recommended as an alternative treatment for SPMS.

Lay abstract

Secondary progressive multiple sclerosis (SPMS) is a subtype of multiple sclerosis that is associated with degeneration of the nervous system. It is a disabling condition and unlike the relapsing-remitting form of multiple sclerosis, the approved medicines for SPMS are fewer and not readily accessible in developing countries because of cost and availability. Thus, neurologists in these areas have fewer treatment options for SPMS. One of these is intravenous methylprednisolone (IVMP), which is an affordable drug. This study looked at the evidence about IVMP in SPMS. However, the evidences are few and do not support the use of IVMP in SPMS because of a lack of efficacy in reducing disability and abnormal findings in the magnetic resonance imaging.

Keywords:

• intravenous methylprednisolone
• multiple sclerosis
• secondary progressive multiple sclerosis
• steroid
• systematic review

Author contributions

FGU Jalipa and AI Espiritu wrote the initial drafts and revisions of the manuscripts. PMD Pasco made substantial contributions in the writing and revisions of the manuscript. All the authors provided substantial intellectual contributions in this study.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Data sharing statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.