THE EFFECT OF CORTICOSTEROIDS FOR ACUTE OPTIC NEURITIS ON THE SUBSEQUENT DEVELOPMENT OF MULTIPLE-SCLEROSIS
THE EFFECT OF CORTICOSTEROIDS FOR ACUTE OPTIC NEURITIS ON THE SUBSEQUENT DEVELOPMENT OF MULTIPLE-SCLEROSIS
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DOI：
10.1056/nejm199312093292403
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发表时间：
1993-12-09
影响因子：
158.5
通讯作者：
BROWN, CH
中科院分区：
文献类型：
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作者：
BECK, RW;CLEARY, PA;BROWN, CH
背景视神经炎通常是多发性硬化的第一个临床表现，但皮质类固醇治疗视神经炎对多发性硬化的后续风险的影响知之甚少。我们进行了一项多中心研究，其中389例急性视神经炎（并且没有已知的多发性硬化症）患者被随机分配接受静脉注射甲泼尼龙（每6小时250 mg）3天，随后口服泼尼松（每公斤体重1 mg）11天，口服泼尼松（每公斤体重1 mg）14天，或安慰剂14天。神经系统状态进行了评估，为期2至4年。第1组患者住院治疗3 d，第2组患者门诊治疗3 d。静脉注射甲泼尼龙组（134例患者）中有7.5%、口服泼尼松组（129例患者）中有14.7%和安慰剂组（126例患者）中有16.7%在头两年内发生了明确的多发性硬化症。与安慰剂组相比，静脉注射甲泼尼龙组在两年内发展为明确多发性硬化的校正率比为0.34（95%置信区间，0.16 ~ 0.74），与口服泼尼松组相比为0.38（95%置信区间，0.17 ~ 0.83）。静脉注射类固醇治疗方案的有益效果在随访的头两年后似乎有所减弱，脑磁共振成像（MRI）信号异常是明确多发性硬化症发生风险的有力指标（有三个或三个以上病灶的患者的校正率比为5.53; 95%置信区间为2.41 ~ 12.66）。治疗的有益效果在入组时MRI扫描异常的患者中最为明显。在急性视神经炎患者中，用三天疗程的大剂量静脉注射甲基强的松龙（随后用短疗程的强的松）治疗可降低多发性硬化症在两年期间的发展率。
Background. Optic neuritis is often the first clinical manifestation of multiple sclerosis, but little is known about the effect of corticosteroid treatment for optic neuritis on the subsequent risk of multiple sclerosis.Methods. We conducted a multicenter study in which 389 patients with acute optic neuritis (and without known multiple sclerosis) were randomly assigned to receive intravenous methylprednisolone (250 mg every six hours) for 3 days followed by oral prednisone (1 mg per kilogram of body weight) for 11 days, oral prednisone (1 mg per kilogram) alone for 14 days, or placebo for 14 days. Neurologic status was assessed over a period of two to four years. The patients in the first group were hospitalized for three days; the others were treated as outpatients.Results. Definite multiple sclerosis developed within the first two years in 7.5 percent of the intravenous-methylprednisolone group (134 patients), 14.7 percent of the oral-prednisone group (129 patients), and 1 6.7 percent of the placebo group (126 patients). The adjusted rate ratio for the development of definite multiple sclerosis within two years in the intravenous-methylprednisolone group was 0.34 (95 percent confidence interval, 0.16 to 0.74) as compared with the placebo group and 0.38 (95 percent confidence interval, 0.17 to 0.83) as compared with the oral-prednisone group. The beneficial effect of the intravenous-steroid regimen appeared to lessen after the first two years of follow-up.Signal abnormalities on magnetic resonance imaging (MRI) of the brain were a strong indication of risk for the development of definite multiple sclerosis (adjusted rate ratio in patients with three or more lesions, 5.53; 95 percent confidence interval, 2.41 to 12.66). The beneficial effect of treatment was most apparent in patients with abnormal MRI scans at entry.Conclusions. In patients with acute optic neuritis, treatment with a three-day course of high-dose intravenous methylprednisolone (followed by a short course of prednisone) reduces the rate of development of multiple sclerosis over a two-year period.