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Corticosteroids for multiple sclerosis: I. Application for treating exacerbations
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  • Review Article
  • Published: October 2007

Corticosteroids for multiple sclerosis: I. Application for treating exacerbations

  • Elliot M. Frohman1,2,
  • Anjali Shah1,2,
  • Eric Eggenberger3,
  • Luanne Metz4,
  • Robert Zivadinov6 &
  • …
  • Olaf Stüve7 

Neurotherapeutics volume 4, pages 618–626 (2007)Cite this article

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  • 35 Citations

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Summary

Multiple sclerosis (MS) is an inflammatory demyelinating disorder characterized by a multiphasic course of neurological exacerbations, periods of clinical remission, and, in most patients, ultimately progressive deterioration of functional capabilities. The relapsing-remitting phase of the disease involves acute interruption in neurological functioning relating to areas of inflammation in discrete central-tract systems. The treatment of MS exacerbations with anti-inflammatory agents such as corticosteroids and adrenocorticotropic hormone has represented an established practice throughout the neurology community. Although there is scientific rationale supporting application of these agents for this purpose, the broad diversity of approaches to using these drugs in clinical practice is a derivative of expert opinion and anecdotal experience. Ultimately, the treatment of MS-related exacerbations is part science, but mostly art. This review discusses the pharmacology of these agents, to better understand how they may act to mitigate attacks and to provide some practical formulations for how to use them in the clinic for the benefit of patients.

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References

  1. Uhthoff W. Untersuchungen über die bei der multiplen Herdsklerose vorkommenden Augenstorungen [In German]. Arch Psychiatr Nervenkrankh 1889;20:55.

    Google Scholar 

  2. Hansen BS, Hussain RZ, Lovett-Racke AE, Thomas JA, Racke MK. Multiple toll-like receptor agonists act as potent adjuvants in the induction of autoimmunity. J Neuroimmunol 2006;172:94–103.

    Article  CAS  PubMed  Google Scholar 

  3. Goodin D, Frohman EM, Garmany GP Jr, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002;58:169–178 [Erratum in: Neurology 2002;59:480].

    CAS  PubMed  Google Scholar 

  4. Dalakas MC. Current treatment of the inflammatory myopathies. Curr Opin Rheumatol 1994;6:595–601.

    Article  CAS  PubMed  Google Scholar 

  5. Kirwan JR; The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995;333:142–146.

    Article  CAS  PubMed  Google Scholar 

  6. Hall S, Conn DL. Immunosuppressive therapy for vasculitis. Curr Opin Rheumatol 1995;7:25–29.

    CAS  PubMed  Google Scholar 

  7. Guillevin L, Lhote F. Distinguishing polyarteritis nodosa from microscopic polyangiitis and implications for treatment. Curr Opin Rheumatol 1995;7:20–24.

    CAS  PubMed  Google Scholar 

  8. Youssef PP, Haynes DR, Triantafillou S, et al. Effects of pulse methylprednisolone on inflammatory mediators in peripheral blood, synovial fluid, and synovial membrane in rheumatoid arthritis. Arthritis Rheum 1997;40:1400–1408.

    Article  CAS  PubMed  Google Scholar 

  9. Droogan AG, Crockard AD, McMillan SA, Hawkins SA. Effects of intravenous methylprednisolone therapy on leukocyte and soluble adhesion molecule expression in MS. Neurology 1998;50:224–229.

    CAS  PubMed  Google Scholar 

  10. Filipovic SR, Drulovic J, Stojsavljevic N, Levic Z. The effects of high-dose intravenous methylprednisolone on event-related potentials in patients with multiple sclerosis. J Neurol Sci 1997;152:147–153.

    Article  CAS  PubMed  Google Scholar 

  11. Patzold T, Schwengelbeck M, Ossege LM, Malin JP, Sindem E. Changes of the MS Functional Composite and EDSS during and after treatment of relapses with methylprednisolone in patients with multiple sclerosis. Acta Neurol Scand 2002; 105:164–168.

    Article  CAS  PubMed  Google Scholar 

  12. Humm AM, Z’Graggen WJ, Buhler R, Magistris MR, Rosier KM. Quantification of central motor conduction deficits in multiple sclerosis patients before and after treatment of acute exacerbation by methylprednisolone. J Neurol Neurosurg Psychiatry 2006;77:345–350.

    Article  CAS  PubMed  Google Scholar 

  13. Buttgereit F, Wehling M, Burmester GR. A new hypothesis of modular glucocorticoid actions: steroid treatment of rheumatic diseases revisited. Arthritis Rheum 1998;41:761–767.

    Article  CAS  PubMed  Google Scholar 

  14. Gold R, Buttgereit F, Toyka KV. Mechanism of action of glucocorticosteroid hormones: possible implications for therapy of neuroimmunological disorders. J Neuroimmunol 2001;117:1–8.

    Article  CAS  PubMed  Google Scholar 

  15. Wehling M. Specific, nongenomic actions of steroid hormones. Annu Rev Physiol 1997;59:365–393.

    Article  CAS  PubMed  Google Scholar 

  16. Boumpas DT, Chrousos GP, Wilder RL, Cupps TR, Balow JE. Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates. Ann Intern Med 1993;119:1198–1208.

    CAS  PubMed  Google Scholar 

  17. Adcock IM, Caramori G, Ito K. New insights into the molecular mechanisms of corticosteroids actions. Curr Drug Targets 2006;7:649–660.

    Article  CAS  PubMed  Google Scholar 

  18. Falkenstein E, Norman AW, Wehling M. Mannheim classification of nongenomically initiated (rapid) steroid action(s). J Clin Endocrinol Metab 2000;85:2072–2075.

    Article  CAS  PubMed  Google Scholar 

  19. Buttgereit F, Brand MD, Burmester GR. Equivalent doses and relative drug potencies for non-genomic glucocorticoid effects: a novel glucocorticoid hierarchy. Biochem Pharmacol 1999;58:363–368.

    Article  CAS  PubMed  Google Scholar 

  20. Yong VW, Power C, Forsyth P, Edwards DR. Metalloproteinases in biology and pathology of the nervous system. Nat Rev Neurosci 2001;2:502–511.

    Article  CAS  PubMed  Google Scholar 

  21. Rosenberg GA, Dencoff JE, Correa N Jr, Reiners M, Ford CC. Effect of steroids on CSF matrix metalloproteinases in multiple sclerosis: relation to blood-brain barrier injury. Neurology 1996; 46:1626–1632.

    CAS  PubMed  Google Scholar 

  22. Orchinik M, Murray TF, Moore FL. A corticosteroid receptor in neuronal membranes. Science 1991;252:1848–1851.

    Article  CAS  PubMed  Google Scholar 

  23. Gametchu B. Glucocorticoid receptor-like antigen in lymphoma cell membranes: con-elation to cell lysis. Science 1987;236:456–461.

    Article  CAS  PubMed  Google Scholar 

  24. Gametchu B, Watson CS, Wu S. Use of receptor antibodies to demonstrate membrane glucocorticoid receptor in cells from human leukemic patients. FASEB J 1993;7:1283–1292.

    CAS  PubMed  Google Scholar 

  25. Diba F, Watson CS, Gametchu B. 5′UTR sequences of the glucocorticoid receptor 1A transcript encode a peptide associated with translational regulation of the glucocorticoid receptor. J Cell Biochem 2001;81:149–161.

    Article  CAS  PubMed  Google Scholar 

  26. Chaudhari BR, Murphy RF, Agrawal DK. Following the TRAIL to apoptosis. Immunol Res 2006;35: 249–262.

    Article  CAS  PubMed  Google Scholar 

  27. Navratil JS, Liu CC, Aheam JM. Apoptosis and autoimmunity. Immunol Res 2006;36:3–12.

    Article  CAS  PubMed  Google Scholar 

  28. Buttgereit F, Krauss S, Brand MD. Methylprednisolone inhibits uptake of Ca2+ and Na+ ions into concanavalin A-stimulated thymocytes. Biochem J 1997;326:329–332.

    CAS  PubMed  Google Scholar 

  29. Schmidt J, Gold R, Schonrock L, Zettl UK, Hartung HP, Toyka KV. T-cell apoptosis in situ in experimental autoimmune enceph-alomyelitis following methylprednisolone pulse therapy. Brain 2000; 123: 1431–1441.

    Article  PubMed  Google Scholar 

  30. Zamvil SS, Steinman L. The T lymphocyte in experimental allergic encephalomyelitis. Annu Rev Immunol 1990;8:579–621.

    Article  CAS  PubMed  Google Scholar 

  31. Levine S, Wenk EJ, Muldoon TN, Cohen SG. Enhancement of experimental allergic encephalomyelitis by adrenalectomy. Proc Soc Exp Biol Med 1962; 111:383–385.

    CAS  PubMed  Google Scholar 

  32. McCombe PA, Nickson I, Tabi Z, Pender MP. Corticosteroid treatment of experimental autoimmune encephalomyelitis in the Lewis rat results in loss of V beta 8.2+ and myelin basic protein-reactive cells from the spinal cord, with increased total T-cell apoptosis but reduced apoptosis of V beta 8.2+ cells. J Neuroimmunol 1996;70:93–101.

    Article  CAS  PubMed  Google Scholar 

  33. Pender MP, Nguyen KB, McCombe PA, Kerr JF. Apoptosis in the nervous system in experimental allergic encephalomyelitis. J Neurol Sci 1991;104:81–87.

    Article  CAS  PubMed  Google Scholar 

  34. Durelli L, Cocito D, Riccio A, et al. High-dose intravenous methylprednisolone in the treatment of multiple sclerosis: clinical-immunologic correlations. Neurology 1986;36:238–243.

    CAS  PubMed  Google Scholar 

  35. Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med 1992;326:581–588.

    Article  CAS  PubMed  Google Scholar 

  36. Sellebjerg F, Frederiksen JL, Nielsen PM, Olesen J. Double-blind, randomized, placebo-controlled study of oral, high-dose methylprednisolone in attacks of MS. Neurology 1998;51:529–534.

    CAS  PubMed  Google Scholar 

  37. Brusaferri F, Candelise L. Steroids for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials. J Neurol 2000;247:435–442.

    Article  CAS  PubMed  Google Scholar 

  38. Rose AS, Kuzma JW, Kurtzke JF, Namerow NS, Sibley WA, Tourtellotte WW. Cooperative study in the evaluation of therapy in multiple sclerosis: ACTH vs. placebo—final report. Neurology 1970;20: 1–59.

    CAS  PubMed  Google Scholar 

  39. Humm AM, Z’Graggen WJ, Buhler R, Magistris MR, Rosier KM. Quantification of central motor conduction deficits in multiple sclerosis patients before and after treatment of acute exacerbation by methylprednisolone. J Neurol Neurosurg Psychiatry 2006;77:345–50.

    Article  CAS  PubMed  Google Scholar 

  40. Filippini G, Brusaferri F, Sibley WA, Citterio A, Ciucci G, Midgard R, Candelise L. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis.

  41. Ciucci G, Midgard R, Candelise L. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev 2000;(4):CD001331.

  42. Hoogervorst EL, Polman CH, Barkhof F. Cerebral volume changes in multiple sclerosis patients treated with high-dose intravenous methylprednisolone. Mult Scler 2002;8:415–419.

    Article  CAS  PubMed  Google Scholar 

  43. Herishanu YO, Badama S, Sarov B, Abarbanel JM, Segal S, Bearman JE. A possible harmful late effect of methylprednisolone therapy on a time cluster of optic neuritis. Acta Neurol Scand 1989;80:569–574.

    Article  CAS  PubMed  Google Scholar 

  44. Stüve O, Marra CM, Jerome K, et al. Immune surveillance in multiple sclerosis patients treated with natalizumab. Ann Neurol 2006;59:743–747.

    Article  PubMed  Google Scholar 

  45. Stiive O, Marra CM, Jerome K, et al. Altered CD4:CD8 T cells ratios in cerebrospinal fluid of natalizumab-treated multiple sclerosis patients. Arch Neurol 2006;63:1383–1387.

    Article  Google Scholar 

  46. Stüve O, Marra CM, Petra CD, et al. The potential risk of progressive multifocal leukoencephalopathy with natalizumab therapy: possible interventions. Arch Neurol 2007;64:169–176.

    Article  PubMed  Google Scholar 

  47. Sellebjerg F, Schaldemose Nielsen H, Fredericksen JL, Olesen J. A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. Neurology 1999;52:1479–1484.

    CAS  PubMed  Google Scholar 

  48. Alam SM, Kyriakides T, Lawden M, Newman PK. Methylprednisolone in multiple sclerosis: a comparison of oral with intravenous therapy at equivalent high dose. J Neurol Neurosurg Psychiatry 1993;56:1219–1220.

    Article  CAS  PubMed  Google Scholar 

  49. Barnes D, Hughes RAC, Morris RW, et al. Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis. Lancet 1997;349:902–906.

    Article  CAS  PubMed  Google Scholar 

  50. Metz LM, Sabuda D, Hilsden RJ, Enns R, Meddings JB. Gastric tolerance of high-dose pulse oral prednisone in multiple sclerosis. Neurology 1999;53:2093–2096.

    CAS  PubMed  Google Scholar 

  51. Morrow SA, Stoian CA, Dmitrovic J, Chan SC, Metz LM. The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis. Neurology 2004;63:1079–1080.

    CAS  PubMed  Google Scholar 

  52. Lackner TE. Interaction of dexamethasone with phenytoin. Pharmacotherapy 1991;11:344–347.

    CAS  PubMed  Google Scholar 

  53. Pradat P, Robert-Gnansia E, Di Tanna GL, Rosano A, Lisi A, Mastroiacovo P; Contributors to the MADRE database. First trimester exposure to corticosteroids and oral clefts. Birth Defects Res A Clin Mol Terato 2003;67:968–970.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., 75235, Dallas, TX

    Elliot M. Frohman & Anjali Shah

  2. Department Ophthalmology, University of Texas Southwestern Medical Center at Dallas, 75235, Dallas, Texas

    Elliot M. Frohman & Anjali Shah

  3. Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, 75235, Dallas, Texas

    Eric Eggenberger

  4. Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan

    Luanne Metz

  5. Department of Neurology, Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York

    Robert Zivadinov

  6. Neurology Section, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas

    Olaf Stüve

Authors
  1. Elliot M. Frohman
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  2. Anjali Shah
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  3. Eric Eggenberger
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  5. Robert Zivadinov
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  6. Olaf Stüve
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Corresponding author

Correspondence to Elliot M. Frohman.

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Frohman, E.M., Shah, A., Eggenberger, E. et al. Corticosteroids for multiple sclerosis: I. Application for treating exacerbations. Neurotherapeutics 4, 618–626 (2007). https://doi.org/10.1016/j.nurt.2007.07.008

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  • Issue Date: October 2007

  • DOI: https://doi.org/10.1016/j.nurt.2007.07.008

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Key Words

  • Corticosteroids
  • ACTH
  • pulse steroids
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