RESEARCH: Corticosteroids for the long-term treatment in multiple sclerosis

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http://tinyurl.com/3y4qruCorticosteroids for the long-term treatment in multiple sclerosis.Ciccone A, Beretta S, Brusaferri F, Galea I, Protti A, Spreafico C.BACKGROUND:

Short term high dose corticosteroid treatment improves symptoms and

short term disability after an acute exacerbation of multiple sclerosis

(MS) but it is unknown whether its long-term use can reduce the

accumulation of disability. OBJECTIVES: To determine the efficacy and

safety of long-term corticosteroid use in MS. SEARCH STRATEGY: We

searched the following bibliographic databases: CENTRAL (Issue 1,

2007), MEDLINE (1966 to February 2007) and EMBASE (1980 to February

2007). In an effort to identify further published, unpublished and

ongoing trials we searched reference lists and contacted trial authors

and one pharmaceutical company. SELECTION CRITERIA: We considered

controlled, randomised trials (RCTs), with or without blinding, of long

term treatment (i.e. longer than 6 months) of any type of

corticosteroid in MS, irrespective of disease course. DATA COLLECTION

AND ANALYSIS: Reviewers independently assessed trial quality and

extracted data. Study authors were contacted for additional

information. MAIN RESULTS: Three trials, all classified at high risk of

bias, contributed to this review ( 1961; BPSM 1995; Zivadinov

2001) resulting in a total of 183 participants (91 treated).

Corticosteroid therapy did not reduce the risk of being worse at the

end of follow-up (odds ratio [OR] 0.51, 95% confidence interval [CI]

0.26 to 1.02) but there was a substantial heterogeneity between studies

(I(2): 78.4%). I. v. periodic high dose methylprednisolone (MP) was

associated with a significant reduction in the risk of disability

progression at 5 years in relapsing-remitting (RR) MS (OR 0.26, 95% CI

0.10 to 0.66), while oral continuous low dose prednisolone was not

associated with any risk reduction in disability progression at 18

months (OR 1.23, 95% CI 0.43 to 3.56). Risk of experiencing at least

one exacerbation at end of follow-up was not significantly reduced with

corticosteroid treatment (OR 0.36; 95% CI 0.10 to 1.25).Only one study

recorded adverse events: in one patient i. v. MP was discontinued after

the fourth pulse when he developed acute glomerulonephritis; a second

patient was removed from the study after the fifth i. v. MP pulse

because of severe osteoporosis. AUTHORS' CONCLUSIONS: There is no

enough evidence that long-term corticosteroid treatment delays

progression of long term disability in patients with MS. Since one

study at high risk of bias showed that the administration of pulsed

high dose i. v. MP is associated with a significant reduction in the

risk of long term disability progression in patients with RR MS, an

adequately powered, high quality RCT is needed to investigate this

finding.PMID: 18254098 [PubMed - in process] This email is a natural hand made product. The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

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