Karadeniz Technical University, Faculty of Medicine, Department of Neurology, Trabzon, Turkey.
Karadeniz Technical University, Faculty of Medicine, Department of Neurology, Trabzon, Turkey.
Clin Neurol Neurosurg. 2020 Oct;197:106118. doi: 10.1016/j.clineuro.2020.106118. Epub 2020 Jul 29.
It is commonly known that women with multiple sclerosis (MS) have an increased risk for relapses during the post-partum period. High-dose IV methylprednisolone is the first-line treatment for acute relapses. Methylprednisolone is administered to lactating women although there is insufficient data as to the levels of concentration in breast milk and serum, and the calculated steroid exposure to infants.
The study aimed to measure the transfer of methylprednisolone into breast milk and the correlation of milk and serum methylprednisolone concentrations in breastfeeding MS patients during and after infusion therapy.
IV methylprednisolone pulse therapy was given to 12 lactating MS patients. Breast milk and maternal serum samples were obtained; before infusion, 30 minutes into the infusion, at the end of infusion and at the 1, 2, 4, 8, 12 and 24 hours subsequently.
The highest level of methylprednisolone concentration in breast milk (2.09 μg/ml) and serum (6.09 μg/ml) was detected at the end of the infusion. According to the measurements recorded at the 1, 2, 4, 8, 12, and 24 hours after infusion, the concentrations showed a gradual decrease both breast milk and serum. The milk and serum methylprednisolone concentrations were below detection limits just before infusion and at the 24 hour after infusion. A highly significant correlation was found between breast milk and maternal serum levels. The absolute infant dose was calculated to be 69.50 μg/kg/day and the relative infant dose (RID) was 0.50%.
Results have shown that the transfer of methylprednisolone into breast milk seems to be low. Although, concentration levels may not seem to pose a threat to the infant, mothers can choose to wait 2 to 4 hours to further limit the level of exposure.
众所周知，多发性硬化症（MS）女性在产后期间复发的风险增加。高剂量静脉注射甲基强的松龙是治疗急性发作的一线药物。尽管关于母乳和血清中的浓度水平以及婴儿的计算类固醇暴露量的数据不足，但仍向哺乳期妇女给予甲基强的松龙。
本研究旨在测量哺乳期 MS 患者在输注期间和输注后甲基强的松龙进入母乳中的转移情况，并研究母乳和血清中甲基强的松龙浓度的相关性。
对 12 名哺乳期 MS 患者进行 IV 甲基强的松龙脉冲治疗。采集母乳和产妇血清样本；在输注前、输注 30 分钟、输注结束时以及随后的 1、2、4、8、12 和 24 小时。
母乳和血清中甲基强的松龙浓度最高（2.09μg/ml 和 6.09μg/ml）出现在输注结束时。根据输注后 1、2、4、8、12 和 24 小时的测量结果，母乳和血清中的浓度逐渐下降。输注前和输注后 24 小时，母乳和血清中的甲基强的松龙浓度均低于检测限。发现母乳和产妇血清水平之间存在高度显著的相关性。婴儿的绝对剂量计算为 69.50μg/kg/天，相对婴儿剂量（RID）为 0.50%。
结果表明，甲基强的松龙进入母乳的转移似乎较低。尽管浓度水平似乎对婴儿没有威胁，但母亲可以选择等待 2 到 4 小时，以进一步限制暴露水平。
