A. B. Rao, MD, N. Richert, PhD, MD, T. Howard, BS, B.K. Lewis, BA, C.N. Bash, MD, H.F. McFarland, MD and J. A. Frank, MD
From the Laboratory of Diagnostic Radiology Research, Clinical Center (Drs. Rao, Richert, Bash, and Frank, T. Howard, and B. Lewis), Neuroimmunology Branch National Institutes of Neurological Diseases and Stroke (Dr. McFarland), NIH, Bethesda, MD; and Department of Radiology (Dr. Rao), Stanford University, CA.
To determine the effect of IV methylprednisolone (IVMP) on brain fraction volume (BFV), contrast-enhancing (CE) lesions, and white matter lesion load (WMLL) in patients with relapsing-remitting MS treated for acute exacerbations.
MRI metrics of MS disease activity are being used as outcome measures in early phase treatment trials, however the short-term effects of IVMP treatment on cerebral atrophy are unknown.
Serial monthly MRI were performed in 26 patients enrolled in a baseline vs treatment trial with interferon ß-1b (IFNß-1b) who were followed for 3 months before and after IVMP.
All 26 patients were evaluated while receiving IFNß-1b, and 12 patients were also studied during the baseline stage of the trial (NHx).
Acute exacerbations were treated with IVMP (1 g/d) for 3 to 5 days.
Precontrast and postcontrast T1-weighted and proton density T2-weighted fast spin-echo images were analyzed.
Fifty-six acute exacerbations were evaluated.
For the 3 months before IVMP, there was no difference in WMLL or BFV compared to month IVMP was administered.
There was a significant decrease in BFV at month 1 after IVMP in the IFNß-1b and NHx groups.
Compared to the month IVMP was administered, there was a difference in the CE lesions for months -3 and -1 prior (p < 0.039) in NHx patients.
Following IVMP, CE lesions decreased (p < 0.0004) for months 1, 2, and 3 in both groups, but there was no effect on WMLL.
BFV and CE lesions were significantly decreased for 1 month (BFV) and 3 months (CE lesions) following IVMP.
Therefore, MRI studies should be delayed by probably at least 2 months following IVMP to avoid a possible confounding steroid effect in a clinical trial.
© 2002 American Academy of Neurology