Updated April 1, 2004
Filippini G, Brusaferri F, Sibley WA, Citterio A, Ciucci G, Midgard R, Candelise L.
Cochrane Review Abstracts
A substantive amendment to this systematic review was last made on 30 July 2000. Cochrane reviews are regularly checked and updated if necessary.
Corticosteroids are often used to improve the rate of recovery from acute exacerbation in multiple sclerosis (MS) patients. However, it is still unclear just how relatively effective these agents are and the type of drug, optimal dose, frequency, duration of treatment and route of administration are unknown.
The objective of this review was to determine the efficacy and safety of corticosteroids or adrenocorticotrophic hormone (ACTH) in reducing the short and long term morbidity from MS. Moreover, we wished to examine from indirect comparisons if the effect of corticosteroids is different according to different doses and drugs, routes of administration, length of treatment.
We searched the Cochrane MS Group trials register (searched October 2002), the Cochrane Central Register of Controlled Trails (CENTRAL) (Issue 4, 2002) and MEDLINE (PubMed) (January 1966 to October 2002) and reference lists of articles. We also undertook handsearching and contacting trialists and pharmaceutical companies.
All randomised, double-blind, unconfounded trials comparing corticosteroids or ACTH to placebo in patients with MS, treated for acute exacerbations, without any age or severity restrictions, were evaluated.
Data collection and analysis:
Two reviewers independently selected articles for inclusion, assessed trials' quality and extracted the data. Study authors were contacted for additional information.
In this update, no new randomised control trials were identified (10/2002). Six trials contributed to this review; a total of 377 participants (199 treatment, 178 placebo) were randomised. The drugs analysed were methylprednisolone (MP) (four trials, 140 participants) and ACTH (two trials, 237 participants). Overall, MP or ACTH showed a protective effect against the disease getting worse or stable within the first five weeks of treatment (odds ratio 0.37, 95% confidence interval 0.24 to 0.57) with some but non significant greater effect for MP and intravenous administration. Short (five days) or long (15 days) duration of treatment with MP did not show any significant difference. No data are available beyond one year of follow-up to indicate whether steroids or ACTH have any effect on long-term progression.One study reported that a short term treatment with high dose intravenous MP was not attended by adverse events. On the contrary, gastrointestinal symptoms and psychic disorders were significantly more common in the oral, high-dose MP than in the placebo group. Weight gain and edema were significantly more frequent in the ACTH group than in controls.
We found evidence favouring the corticosteroid MP for acute exacerbation in MS patients. Data are insufficient to reliably estimate effect of corticosteroids on prevention of new exacerbations and reduction of long-term disability.Studies assessing long term risk/benefit and adverse effects of corticosteroids in MS patients are urgently needed.
Filippini G, Brusaferri F, Sibley WA, Citterio A, Ciucci G, Midgard
R, Candelise L. Corticosteroids or ACTH for acute exacerbations in multiple
sclerosis (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester,
UK: John Wiley & Sons, Ltd.
Copyright © 2004, The Cochrane Collaboration