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A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS.
Neurology 2009; 73(22):1842-8Neur

Abstract

OBJECTIVE

To compare the efficacy, tolerability, and safety of IV methylprednisolone (IV MP) vs oral methylprednisolone (oMP) at equivalent high doses in patients with multiple sclerosis (MS) experiencing a recent relapse.

METHODS

Patients with a clinical relapse within the previous 2 weeks and at least 1 gadolinium (Gd)-enhancing lesion on a screening brain MRI scan were included. Forty patients with MS were randomized to receive either 1 g/day for 5 days of oMP (20 patients) or 1 g/day for 5 days of IV MP (20 patients). Expanded Disability Status Scale (EDSS) and brain MRI (dual-echo and postcontrast T1-weighted scans) were assessed at baseline and at weeks 1 and 4. The study primary research question (endpoint) was to compare the efficacy of the 2 treatment routes in reducing the number of Gd-enhancing lesions after 1 week from treatment initiation. Secondary outcomes were safety, tolerability, and clinical efficacy profiles of the 2 routes of administration.

RESULTS

The 2 groups showed a reduction of Gd-enhancing lesions over time (p = 0.002 for oMP and p = 0.001 for IV MP) with a "non-inferiority effect" between the 2 routes of administration at week 1. Both groups showed an improvement of EDSS over time (p < 0.001) without between-group difference at week 4. Both treatments were well-tolerated and adverse events were minimal and occurred similarly in the 2 treatment arms.

CONCLUSIONS

Oral methylprednisolone (oMP) is as effective as IV methylprednisolone in reducing gadolinium-enhancing lesions in patients with MS soon after an acute relapse with similar clinical, safety, and tolerability profiles. This study provides class III evidence that 1 g oMP x 5 days is not inferior to 1 g IV MP x 5 days in reducing the number of gadolinium-enhancing lesions over a period of 1 week (mean difference in lesion reduction comparing IV MP to oMP is -20%, 95% confidence interval -48% to + 5%).

Authors+Show Affiliations

Department of Neurology, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy. massimo.filippi@hsr.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19949030

Citation

Martinelli, V, et al. "A Short-term Randomized MRI Study of High-dose Oral Vs Intravenous Methylprednisolone in MS." Neurology, vol. 73, no. 22, 2009, pp. 1842-8.
Martinelli V, Rocca MA, Annovazzi P, et al. A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. Neurology. 2009;73(22):1842-8.
Martinelli, V., Rocca, M. A., Annovazzi, P., Pulizzi, A., Rodegher, M., Martinelli Boneschi, F., ... Filippi, M. (2009). A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. Neurology, 73(22), pp. 1842-8. doi:10.1212/WNL.0b013e3181c3fd5b.
Martinelli V, et al. A Short-term Randomized MRI Study of High-dose Oral Vs Intravenous Methylprednisolone in MS. Neurology. 2009 Dec 1;73(22):1842-8. PubMed PMID: 19949030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. AU - Martinelli,V, AU - Rocca,M A, AU - Annovazzi,P, AU - Pulizzi,A, AU - Rodegher,M, AU - Martinelli Boneschi,F, AU - Scotti,R, AU - Falini,A, AU - Sormani,M P, AU - Comi,G, AU - Filippi,M, PY - 2009/12/2/entrez PY - 2009/12/2/pubmed PY - 2009/12/23/medline SP - 1842 EP - 8 JF - Neurology JO - Neurology VL - 73 IS - 22 N2 - OBJECTIVE: To compare the efficacy, tolerability, and safety of IV methylprednisolone (IV MP) vs oral methylprednisolone (oMP) at equivalent high doses in patients with multiple sclerosis (MS) experiencing a recent relapse. METHODS: Patients with a clinical relapse within the previous 2 weeks and at least 1 gadolinium (Gd)-enhancing lesion on a screening brain MRI scan were included. Forty patients with MS were randomized to receive either 1 g/day for 5 days of oMP (20 patients) or 1 g/day for 5 days of IV MP (20 patients). Expanded Disability Status Scale (EDSS) and brain MRI (dual-echo and postcontrast T1-weighted scans) were assessed at baseline and at weeks 1 and 4. The study primary research question (endpoint) was to compare the efficacy of the 2 treatment routes in reducing the number of Gd-enhancing lesions after 1 week from treatment initiation. Secondary outcomes were safety, tolerability, and clinical efficacy profiles of the 2 routes of administration. RESULTS: The 2 groups showed a reduction of Gd-enhancing lesions over time (p = 0.002 for oMP and p = 0.001 for IV MP) with a "non-inferiority effect" between the 2 routes of administration at week 1. Both groups showed an improvement of EDSS over time (p < 0.001) without between-group difference at week 4. Both treatments were well-tolerated and adverse events were minimal and occurred similarly in the 2 treatment arms. CONCLUSIONS: Oral methylprednisolone (oMP) is as effective as IV methylprednisolone in reducing gadolinium-enhancing lesions in patients with MS soon after an acute relapse with similar clinical, safety, and tolerability profiles. This study provides class III evidence that 1 g oMP x 5 days is not inferior to 1 g IV MP x 5 days in reducing the number of gadolinium-enhancing lesions over a period of 1 week (mean difference in lesion reduction comparing IV MP to oMP is -20%, 95% confidence interval -48% to + 5%). SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/19949030/A_short_term_randomized_MRI_study_of_high_dose_oral_vs_intravenous_methylprednisolone_in_MS_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=19949030 DB - PRIME DP - Unbound Medicine ER -