Methylprednisolone effect on brain volume and enhancing lesions in MS before and during IFNβ-1b
Methylprednisolone effect on brain volume and enhancing lesions in MS before and during IFNβ-1b
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DOI：
10.1212/wnl.59.5.688
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发表时间：
2002-09-10
期刊：
影响因子：
9.9
通讯作者：
Frank, JA
中科院分区：
文献类型：
--
作者：
Rao, AB;Richert, N;Frank, JA
目的：确定IV甲基强的松龙（IVMP）对复发缓解型MS急性加重治疗患者的脑体积分数（BFV）、对比增强（CE）病变和白色病变负荷（WMLL）的影响。背景资料：MS疾病活动性的MRI指标被用作早期治疗试验的结局指标，然而IVMP治疗对脑萎缩的短期影响尚不清楚。方法：在IVMP治疗前后随访3个月的26例患者中进行连续每月MRI，这些患者参加了干扰素β-1b（IFN β-1b）基线与治疗试验。所有26名患者在接受IFN β-1b治疗时进行了评估，12名患者在试验的基线阶段（NHx）也进行了研究。急性加重用IVMP（1 g/d）治疗3 - 5天。分析对比剂前和对比剂后T1加权和质子密度T2加权快速自旋回波图像。结果：评价了五十六例急性加重。IVMP给药前3个月，与IVMP给药月相比，WMLL或BFV无差异。IFN β-1b和NHx组IVMP后1个月BFV显著降低。与给予IVMP的月份相比，NHx患者在之前-3个月和-1个月的CE病变存在差异（p < 0.039）。IVMP后1、2和3个月，两组CE病变均减少（p < 0.0004），但对WMLL无影响。结论：IVMP后1个月（BFV）和3个月（CE病变）BFV和CE病变显著减少。因此，MRI研究应在IVMP后至少延迟2个月，以避免临床试验中可能的混杂类固醇效应。
Objective: 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. Background: 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, Methods: Serial monthly MRI were performed in 26 patients enrolled in a baseline vs treatment trial with interferon beta-1b (IFNbeta-1b) who were followed for 3 months before and after IVMP. All 26 patients were evaluated while receiving IFNbeta-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. Results: 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 IFNbeta-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, Conclusions: 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.