Bazi Aliyeh, Baghbanian Seyed Mohammad, Ghazaeian Monireh, Fallah Sahar, Hendoiee Narjes
Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Neurology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Can J Infect Dis Med Microbiol. 2021 Jan 31;2021:6616763. doi: 10.1155/2021/6616763. eCollection 2021.
The first treatment for multiple sclerosis exacerbation is usually short-term intravenous methylprednisolone (IVMP), with or without a regimen of oral prednisone taper (OPT). This study aims to evaluate the effects of IVMP and OPT in comparison with IVMP alone in raising the risk of urinary tract infection (UTI) and posttreatment improvement of urinary tract symptoms in patients with relapsing-remitting multiple sclerosis. This double-blind randomized clinical trial was conducted on 56 people with multiple sclerosis relapse who had undergone methylprednisolone for 5 days. Patients were randomly split into two groups: oral prednisolone and placebo (tapering for 20 days). Demographic data, duration of multiple sclerosis, urinary tract symptoms, the Expanded Disability Status Scale (EDSS) score, and urine data were analyzed. The incidence of UTI in the intervention and control groups did not differ significantly (=560). However, the improvement of urinary tract symptoms in the intervention group was significantly more favorable than in the control group ( ≤ 0.001). Furthermore, administering OPT after IVMP did not increase the risk of UTI occurrence in patients with multiple sclerosis exacerbation. The urine analysis results did not show any differences at baseline and after the corticosteroid tapering regimen. Due to the risk of infection by corticosteroids, it is no longer necessary to do further urinary screening in this group of patients.
多发性硬化症发作的首要治疗方法通常是短期静脉注射甲基泼尼松龙(IVMP),可联合或不联合口服泼尼松逐渐减量方案(OPT)。本研究旨在评估IVMP联合OPT与单纯使用IVMP相比,对复发缓解型多发性硬化症患者发生尿路感染(UTI)风险及治疗后尿路症状改善情况的影响。这项双盲随机临床试验针对56例接受了5天甲基泼尼松龙治疗的多发性硬化症复发患者开展。患者被随机分为两组:口服泼尼松龙组和安慰剂组(逐渐减量20天)。对人口统计学数据、多发性硬化症病程、尿路症状、扩展残疾状态量表(EDSS)评分及尿液数据进行了分析。干预组和对照组的UTI发生率无显著差异(=560)。然而,干预组尿路症状的改善明显优于对照组(≤0.001)。此外,在IVMP治疗后给予OPT并未增加多发性硬化症发作患者发生UTI的风险。尿液分析结果在基线及皮质类固醇逐渐减量方案实施后未显示出任何差异。鉴于皮质类固醇存在感染风险,该组患者不再需要进行进一步的尿液筛查。