Efficacy of methylprednisolone pulse therapy for acute relapse in Japanese patients with multiple sclerosis and neuromyelitis optica: A multicenter retrospective analysis - 1. Whole group analysis

Jun Ichi Kira, Ryo Yamasaki, Satoshi Yoshimura, Toshiyuki Fukazawa, Kazumasa Yokoyama, Kazuo Fujihara, Mieko Ogino, Takanori Yokota, Katsuichi Miyamoto, Masaaki Niino, Kyoichi Nomura, Ryo Tomioka, Masami Tanaka, Izumi Kawachi, Takashi Ohashi, Kenichi Kaida, Makoto Matsui, Yuji Nakatsuji, Hirofumi Ochi, Hikoaki FukauraTakashi Kanda, Akiko Nagaishi, Kanae Togo, Hidehiro Mizusawa, Yuji Kawano

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6 Citations (Scopus)

Abstract

Objectives There has been no large-scale study of methylprednisolone pulse therapy in Asian patients with multiple sclerosis (MS) or neuromyelitis optica (NMO), despite it being widely used for acute relapse. We aimed to clarify treatment response of MS and NMO patients to methylprednisolone pulse therapy and post-pulse oral corticosteroids in real clinical practice in a multicenter study in Japan. Methods Investigators at 28 institutions collected changes in neurological symptoms/signs and Expanded Disability Status Scale (EDSS) scores before and within 1 week of completion of methylprednisolone pulse therapy carried out in 2010, and after post-pulse oral corticosteroids therapy, by retrospective review of medical records. Results In 345 patients (95.1% of all registered patients), 457 series of methylprednisolone pulse therapy were carried out for treatment of acute relapse. EDSS scores improved by 0.8 ± 1.1 (mean ± SD) after the first course. The second and third courses also produced sufficient improvements (by 0.7 and 0.6, respectively), but much smaller improvements were observed thereafter. The target neurological symptoms and signs improved in 79.5% of patients. Improvement rates were 5-20% lower after a course of pulse therapy than after a series of pulse therapy. A half dose (500 mg/day) produced less improvement than a standard dose (1000 mg/day; 65.9 vs 79.5%). During post-pulse oral corticosteroid therapy, EDSS scores decreased by 0.6 ± 0.9. No significant adverse effects were observed. Conclusions Methylprednisolone pulse therapy is beneficial in nearly 80% of Japanese MS and NMO patients, and EDSS score improvements after therapy are compatible with those in Western MS patients.

Original languageEnglish
Pages (from-to)305-317
Number of pages13
JournalClinical and Experimental Neuroimmunology
Volume4
Issue number3
DOIs
Publication statusPublished - 2013 Dec

Keywords

  • corticosteroids
  • methylprednisolone
  • multiple sclerosis
  • neuromyelitis optica
  • pulse therapy

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Immunology
  • Immunology and Microbiology (miscellaneous)
  • Clinical Neurology

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    Kira, J. I., Yamasaki, R., Yoshimura, S., Fukazawa, T., Yokoyama, K., Fujihara, K., Ogino, M., Yokota, T., Miyamoto, K., Niino, M., Nomura, K., Tomioka, R., Tanaka, M., Kawachi, I., Ohashi, T., Kaida, K., Matsui, M., Nakatsuji, Y., Ochi, H., ... Kawano, Y. (2013). Efficacy of methylprednisolone pulse therapy for acute relapse in Japanese patients with multiple sclerosis and neuromyelitis optica: A multicenter retrospective analysis - 1. Whole group analysis. Clinical and Experimental Neuroimmunology, 4(3), 305-317. https://doi.org/10.1111/cen3.12071