Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS

Thompson, Andrew; Kennard, C; Swash, Michael; Summers, Beverley; Yuill, G. M.; Shepherd, D I; Roche, S.; Perkin, G D; Loizou, Loizos; Ferner, Robin E; Hughes, Rebecca; Thompson, M.; Hand, Jonathan

doi:10.1212/wnl.39.7.969

Cited by 116 publications

(84 citation statements)

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“…Additionally, daily administration of 500-1000 mg of MP increases serum steroid peak levels 5-10 times more compared with ACTH administration (54). Despite these, positive effects equivalent to MP have been reported with ACTH use in relapse treatment (59,60,61). This effect is attributed to the direct anti-inflammatory and immunomodulatory effects of ACTH through melanocortin receptors.…”

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

“…This effect is attributed to the direct anti-inflammatory and immunomodulatory effects of ACTH through melanocortin receptors. ACTH is showed to be effective in opsoclonus-myoclonus and infantile spasms via the melanocortin receptors whereas synthetic steroids are found to be ineffective in these conditions (62,63,64).…”

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

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Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

Section: Adrenocorticotropic Hormone and Steroidsmentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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“…Of four trials that examined short-term treatment of patients with MS with an ACTH analogue compared with either placebo [Rose et al 1970] or IV MP [Abbruzzese et al 1983;Barnes et al 1985;Thompson et al 1989], few provided data pertinent to mood changes. A large study of 197 MS patients (n = 103, ACTH; n = 94, placebo) reported some evidence, albeit limited, of improvement in mood, but without further details about the types of mood changes [Rose et al 1970].…”

Section: Discussionmentioning

confidence: 99%

“…One study specified that of the three patients on MP and two on ACTH who failed to complete the study, one patient on ACTH 'became agitated and paranoid' on day 13 of treatment and was withdrawn from the study, though no other details were provided [Thompson et al 1989]. Finally, two of the studies of patients receiving either ACTH or MP did not provide information regarding mood changes in either group [Abbruzzese et al 1983;Barnes et al 1985].…”

Section: Discussionmentioning

confidence: 99%

Clinical experience with repository corticotropin injection in patients with multiple sclerosis experiencing mood changes with intravenous methylprednisolone: a case series

Murray¹,

Woo²

2015

Ther Adv Neurol Disord

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The elevated prevalence of neuropsychiatric symptoms and disorders among patients with multiple sclerosis (MS) is well recognized, as are potential neuropsychiatric side effects of treatment with corticosteroids. Both methylprednisolone (MP) and repository corticotropin injection (HP Acthar® gel) have demonstrated efficacy in reducing short-term disability after exacerbations of MS. Although historical data are limited, repository corticotropin injection has not generally been associated with detrimental neuropsychiatric effects. We describe six cases of patients with relapsing-remitting MS who had previously experienced detrimental mood changes with MP treatment. Some of these patients had previous histories of mood disorders or other neuropsychiatric symptoms prior to MS diagnosis. All six patients were subsequently treated with repository corticotropin injection for MS exacerbations and each demonstrated improvements in MS symptoms. This clinical experience suggests that repository corticotropin injection should be considered as an alternative for patients who do not tolerate corticosteroids or have difficulties associated with intravenous medication. Furthermore, the rate of neuropsychiatric side effects observed in these patients was low. These observations support repository corticotropin injection as a viable alternative for the treatment of acute exacerbations of MS, particularly in patients who have a history of neuropsychiatric disorders or symptoms either independently or in response to MP treatment. In reviewing both the published data and our own clinical experience regarding potential neuropsychiatric adverse events with treatment for MS exacerbations, we hope to stimulate further research into the potential efficacy and safety of repository corticotropin injection among patients with some form of neuropsychiatric complications that must be considered when establishing a treatment plan for MS.

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“…Hyperglycemia, hypertension, moon face, and hirsutism were less frequently reported [2,3,[18][19][20][21][22][23][24][25].…”

Section: Adverse Events During Steroid and Acth Therapymentioning

confidence: 96%

Treatment of Acute Relapses in Multiple Sclerosis

Berkovich

2016

Translational Neuroimmunology in Multiple Sclerosis

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Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS

Cited by 116 publications

References 0 publications

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Clinical experience with repository corticotropin injection in patients with multiple sclerosis experiencing mood changes with intravenous methylprednisolone: a case series

Treatment of Acute Relapses in Multiple Sclerosis

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