Effect of high–dose intravenous steriod administration on contrast‐enhancing computed tomographic scan lesions in multiple sclerosis

Troiano, Raymond; Hafstein, Marino P.; Ruderman, Marvin I.; Dowling, Peter C.; Cook, Stuart D.

doi:10.1002/ana.410150309

Cited by 59 publications

(12 citation statements)

References 27 publications

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“…Atorvastatin treatment was continued during relapse treatment. However, in the case of MP administration, subsequent MRI examination was postponed to ensure an interval of 4 weeks after the last day of MP application, so as to avoid confounding effects of corticosteroid treatment on MRI contrast enhancement [10]. The same interval was adhered to with regards to relapses requiring MP treatment prior to the screening MRI.…”

Section: Methodsmentioning

confidence: 99%

Oral High-Dose Atorvastatin Treatment in Relapsing-Remitting Multiple Sclerosis

et al. 2008

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BackgroundRecent data from animal models of multiple sclerosis (MS) and from a pilot study indicated a possible beneficial impact of statins on MS.Methodology/Principal FindingsSafety, tolerability and effects on disease activity of atorvastatin given alone or in combination with interferon-beta (IFN-β) were assessed in a phase II open-label baseline-to-treatment trial in relapsing-remitting MS (RRMS). Patients with at least one gadolinium-enhancing lesion (CEL) at screening by magnetic resonance imaging (MRI) were eligible for the study. After a baseline period of 3 monthly MRI scans (months −2 to 0), patients followed a 9-month treatment period on 80 mg atorvastatin daily. The number of CEL in treatment months 6 to 9 compared to baseline served as the primary endpoint. Other MRI-based parameters as well as changes in clinical scores and immune responses served as secondary endpoints. Of 80 RRMS patients screened, 41 were included, among them 16 with IFN-β comedication. The high dose of 80 mg atorvastatin was well tolerated in the majority of patients, regardless of IFN-β comedication. Atorvastatin treatment led to a substantial reduction in the number and volume of CEL in two-sided multivariate analysis (p = 0.003 and p = 0.008). A trend towards a significant decrease in number and volume of CEL was also detected in patients with IFN-β comedication (p = 0.060 and p = 0.062), in contrast to patients without IFN-β comedication (p = 0.170 and p = 0.140). Immunological investigations showed no suppression in T cell response but a significant increase in IL-10 production.Conclusions/SignificanceOur data suggest that high-dose atorvastatin treatment in RRMS is safe and well tolerated. Moreover, MRI analysis indicates a possible beneficial effect of atorvastatin, alone or in combination with IFN-β, on the development of new CEL. Thus, our findings provide a rationale for phase II/III trials, including combination of atorvastatin with already approved immunomodulatory therapy regimens.Trial RegistrationClinicalTrials.gov NCT00616187

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Section: Methodsmentioning

confidence: 99%

Oral High-Dose Atorvastatin Treatment in Relapsing-Remitting Multiple Sclerosis

et al. 2008

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“…(24) (12) (8) (4) between the use and dosage of dexamethasone and the presence of enhancement at the resection line. Movement and artifacts were less marked on postoperative day 3 or 4 than on day 1 or 2.…”

Section: Results Of Sequential Postoperative Computed Tomographic Scansmentioning

confidence: 99%

Postoperative contrast enhancement in patients with brain tumor

Cairncross

Pexman

Rathbone

et al. 1985

Annals of Neurology

113

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Contrast enhancement resulting from surgical trauma may mimic residual enhancing tumor, thereby complicating the interpretation of postoperative computed tomographic scans. We assessed the natural history of postoperative enhancement in 10 patients with brain tumor. Contrast enhancement distinguishable from residual enhancing tumor appeared along the operative margin following tumor resections but not lobectomies. Enhancement appeared as early as the fifth postoperative day, was most intense at two weeks, and persisted for several months. Prior to the fifth postoperative day, enhancement reflected residual tumor. Edema and artifacts were more prominent on the first and second postoperative days than on the third and fourth. We recommend that postoperative computed tomographic scans to assess residual enhancing tumor be performed on the third or fourth postoperative day. This timing avoids postoperative enhancement and minimizes interpretative difficulties caused by artifacts.

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“…8,9 It is therefore likely that IVMP acutely restores blood-brain barrier function, thus reducing fluid extravasation into the brain parenchyma.…”

Section: Discussionmentioning

confidence: 99%