Similar biological effect of high-dose oral versus intravenous methylprednisolone in multiple sclerosis relapses

Grau-López, Laia; Teniente-Serra, Aina; Tintoré, Mar; Ramió-Torrentà, Lluı́s; Brieva, Luís; Sáiz, Albert; Cano, Antonio; Carmona, Olga; Hervás, JV; Martínez-Cáceres, Eva; Ramo-Tello, Cristina

doi:10.1177/1352458514546786

Cited by 6 publications

(4 citation statements)

References 14 publications

(32 reference statements)

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“…Among the remaining articles, 58 articles were excluded based on titles and abstracts, as the participants and interventions in these studies were irrelevant to the aim of this meta-analysis. Finally, the remaining 9 studies were potentially eligible articles [ 12 – 16 , 18 , 22 – 24 ]. After reviewing the full article, we found that three of them were based on one trial [ 13 , 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, two of them were excluded [ 22 , 23 ]. Two other articles were based on the same trial [ 15 , 24 ] and, again, one of them was rejected [ 24 ]. One article only compared the bioavailability of glucocorticoids between oral and intravenous administration but not clinical efficacy; therefore, we discarded this study as well [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

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Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2017

PLoS ONE

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BackgroundIntravenous glucocorticoids are recommended for multiple sclerosis (MS). However, they can be inconvenient and expensive. Due to their convenience and low cost, oral glucocorticoids may be an alternative treatment. Recently, several studies have shown that there is no difference in efficacy and safety between oral methylprednisolone (oMP) and intravenous methylprednisolone (ivMP).ObjectivesWe sought to assess the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses in this meta-analysis.MethodsRandomized controlled trials (RCTs) evaluating the clinical efficacy, safety and tolerability of oral methylprednisolone versus intravenous methylprednisolone for MS relapses were searched in PubMed, Cochrane Library, Medline, EMBASE and China Biology Medicine until October 25, 2016, without language restrictions. The proportion of patients who had improved by day 28 was chosen as the efficacy outcome. We chose the risk ratio (RR) to analyze each trial with the 95% confidence interval (95% CI). We also used the fixed-effects model (Mantel–Haenszel approach) to calculate the pooled relative effect estimates.ResultsA total of 5 trials were identified, which included 369 patients. The results of our meta-analysis revealed that no significant difference existed in relapse improvement at day 28 between oMP and ivMP (RR 0.96, 95% CI 0.84 to 1.10). No evidence of heterogeneity existed among the trials (P = 0.45, I2 = 0%). Both treatments were equally safe and well tolerated except that insomnia was more likely to occur in the oMP group compared to the ivMP group.ConclusionOur meta-analysis reveals strong evidence that oMP is not inferior to ivMP in increasing the proportion of patients experiencing clinical improvement at day 28. In addition, both routes of administration are equally well tolerated and safe. These findings suggest that we may be able to replace ivMP with oMP to treat MS relapses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Liu

Chen

et al. 2017

PLoS ONE

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“…16 It demonstrated that there was no significant difference in the measured absorption of bioequivalent doses of oral prednisone vs. intravenous methylprednisolone. Two studies 7,26 suggested that no significant differences were found in peripheral blood T lymphocyte adhesion molecule expression, T cell subset distribution, TNFα concentrations or cytokine levels in patients of MS relapses whether treated with OMP or IVMP, providing further support to the concept that the two regimens are equivalent and their biological effect similar.…”

Section: ■ Discussionmentioning

confidence: 99%

Oral versus intravenous steroid therapy for relapses in patients with multiple sclerosis: an updated meta-analysis of six randomized controlled trials

Luo¹,

Han²,

Wei³

et al. 2017

Medical Express

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PURPOSE:To systematically evaluate whether oral steroids can be used with the same efficacy and safety in comparison with the intravenous regimen for treatment of multiple sclerosis relapses. METHOD: We searched Medline, Embase and Cochrane Library and systematically reviewed articles comparing outcomes of oral versus intravenous steroids for acute relapses in patients with a clinically definite diagnosis of multiple sclerosis. RESULTS: Six articles with 414 participants in total were analyzed. Five of the included trials reported the proportion of patients experiencing improvement in Expanded Disability Status Scale after receiving either oral or intravenous methylprednisolone treatment at four weeks; the pooled results showed that there was no statistically significant difference (OR 0.96; 95% CI 0.60, 1.54; p=0.86) between treatments. Three trials reported the detailed results of adverse events, indicating the two treatments appear to be equally safe. Two trials revealed that there was no significant difference in gadolinium enhancement activity on magnetic resonance imaging. One trial showed that the mean area under the concentration-time curve (AUC) at 24 and 48 hours did not differ between groups. CONCLUSION: No significant differences were found in terms of clinical (benefits and adverse events), radiological and pharmacological outcomes in multiple sclerosis relapses in patients after oral or intravenous steroids treatment. Our meta-analysis provides evidence that oral steroid therapy is not inferior to intravenous steroid therapy. Thus oral administration may be a favorable substitute for intravenous medication of multiple sclerosis relapses.

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“…Therapeutic options to treat MS relapses include oral glucocorticosteroids [70,71] or their intravenous administration at a high dose as first line and therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) as second line treatments in glucocorticosteroids unresponsive patients [72], corticotrophin injection and Acthar [73].…”

Section: Treatment Of Relapsesmentioning

confidence: 99%

Sleep Disorders in Multiple Sclerosis

González-Platas¹,

Martin²

2018

Neuroplasticity - Insights of Neural Reorganization

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Patients with multiple sclerosis (MS) have multiple causes of poor sleep and potential triggers may relate to MS-related symptoms, co-morbidities and adverse effects from medication. Sleep disorders may occur independently of demographic factors, gender and clinical condition. The real frequency of sleep disturbances in MS and their impact on the patients' quality of life are unknown. The prevalence of sleep problems in the population with MS ranges between 47 and 62% and is more frequent in women, as well as having a higher risk of mortality. High psychological burden has been associated with poor sleep and with increased risk of co-morbid conditions such as heart disease, obesity, dyslipidemia and diabetes, which may have a profound impact on long-term health. The poor sleeping patients with MS were more likely to report fatigue and sleepiness. Insomnia is present in mood disorders, restless leg syndrome (RLS), pain, nocturia and obstructive sleep apnea (OSA), in patients with MS. All the symptoms are intermixed, and it is not possible to discern the precipitating factor or the perpetuating factor. Clinicians should routinely ask about sleep when forming a comprehensive care plan for patients with MS. Sleep specialty referrals should be considered for management of conditions that require polysomnography (PSG) diagnosis.

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Similar biological effect of high-dose oral versus intravenous methylprednisolone in multiple sclerosis relapses

Abstract: clinicaltrials.gov identifier: NCT00753792.

Cited by 6 publications

References 14 publications

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials

Oral versus intravenous steroid therapy for relapses in patients with multiple sclerosis: an updated meta-analysis of six randomized controlled trials

Sleep Disorders in Multiple Sclerosis

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