Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Sapporo Neurology Clinic, Sapporo, Japan.
Mult Scler. 2016 Sep;22(10):1337-48. doi: 10.1177/1352458515617248. Epub 2015 Nov 12.
No large-scale studies have compared the efficacy of intravenous methylprednisolone pulse therapy (IVMP) for multiple sclerosis (MS) and neuromyelitis optica (NMO).
To explain differences in treatment responses of MS and NMO patients to IVMP.
Changes in neurological symptoms/signs and Expanded Disability Status Scale (EDSS) scores before and within 1 week of IVMP completion were obtained in 2010 at 28 institutions, and retrospectively collated from 271 MS (478 courses) and 73 NMO (118 courses) cases.
In MS patients, decreased EDSS score was significant after the first (-0.8 ± 0.9), second (-0.7 ± 0.9), and third (-0.7 ± 0.8) courses (p < 0.05), but not after the fourth (-0.3 ± 0.7) and fifth (-0.5 ± 0.6). However, decreased EDSS score was only significant after the first course (-0.5 ± 1.5, p < 0.05) in NMO patients. EDSS score was significantly decreased in MS compared with NMO patients at the first course (p < 0.05), but not thereafter. Model analysis for EDSS score improvement at the first course, adjusting for covariates, showed significantly greater decreases in MS compared with NMO patients (p < 0.05).
IVMP is effective in MS from the first to third courses, and in NMO at the first course. Additionally, IVMP is more efficacious in MS than NMO patients, even at the first course.
尚无大规模研究比较静脉注射甲泼尼龙脉冲疗法（IVMP）治疗多发性硬化症（MS）和视神经脊髓炎（NMO）的疗效。
解释 MS 和 NMO 患者对 IVMP 治疗反应的差异。
2010 年在 28 家机构中获得了 271 例 MS（478 疗程）和 73 例 NMO（118 疗程）患者在 IVMP 完成前 1 周内的神经系统症状/体征和扩展残疾状态量表（EDSS）评分变化情况，并进行回顾性汇总。
在 MS 患者中，第 1 次（-0.8±0.9）、第 2 次（-0.7±0.9）和第 3 次（-0.7±0.8）疗程后 EDSS 评分降低具有统计学意义（p<0.05），但第 4 次（-0.3±0.7）和第 5 次（-0.5±0.6）疗程后无统计学意义。然而，在 NMO 患者中，仅第 1 次疗程（-0.5±1.5）后 EDSS 评分降低具有统计学意义（p<0.05）。MS 患者的 EDSS 评分在第 1 次疗程后显著低于 NMO 患者（p<0.05），但此后无差异。调整协变量后，第 1 次疗程 EDSS 评分改善的模型分析显示，MS 患者的 EDSS 评分下降幅度明显大于 NMO 患者（p<0.05）。
IVMP 在 MS 患者中从第 1 次到第 3 次疗程有效，在 NMO 患者中第 1 次疗程有效。此外，即使在第 1 次疗程，IVMP 在 MS 患者中也比 NMO 患者更有效。
