THE EFFICIENCY OF GLUCOCORTICOID THERAPY IN SECONDARY-PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS

Vitaliy Vasylovskyy

Abstract


We have investigated the efficacy of pulse-therapy with glucocorticoids (GC) at different time stages (in debuts, at the recurrent stage and at the stage of progression) of secondary progressive course (SPC) of multiple sclerosis (MS) in 70 patients (57 women and 13 men) at the ages from 28 to 67 years (mean age 45±2.5 years). The duration of the disease accounted for 7 up to 34 years (average duration was 19.8±2.3 years). We have conducted 438 courses of GC therapy: at the onsets – 11, at the recurrent stage (RS) – 178 and at the stage of secondary progression-249.

The efficacy of hormonal therapy was assessed taking into account the following criteria: the dynamics of regression of neurological symptoms under the influence of the first course of GC therapy at the stage of onsets; a comparative evaluation of remission’s duration after admission and without taking GC at the onsets; duration of RS depending on the duration of remissions after the first course of GC therapy; a comparative evaluation of remissions’ duration after the 1st (at the stage of onset and/or on the RS), and the period of stabilization on the SPS before the last courses of GC; the variants of secondary progression under the influence of GC courses; scores according the EDSS disability scale after the 1st and before the last course of GC therapy; the rate of progression under the influence of the repeated courses of GC therapy.

We have defined the three categories of efficacy at the repeated courses of pulse therapy with GC: the moderate efficacy, the low efficacy, the lack of efficacy. We have not observed the high efficacy in patients with SPC.

The patients with MFR <1.0, among which the pulse therapy with GC promoted the prolongation of RS, relieved the severe (less often) and moderate (more often) relapses, the outcome of which was accompanied by a moderate and stable neurologic deficit, were subsumed under the subgroup with moderate efficacy (21 individuals). The most favorable progressive variant of progression prevailed in these patients after transformation of RS into SPS.

The patients with different rate of MFR (9 – with MFR <1.0 and 12 – with MFR>1.0), with short (more often) and moderate (less often) RS, during which the accumulation of neurological deficit due to the frequent and heavy relapses had occurred, were subsumed under the subgroup with low efficiency (21 individuals). After transformation into SPS, the recurrent variant of progression prevailed in these patients.

The patients who were characterized by short RS, by predominance of severe and prolonged relapses, the MFR value greater than 1.0, the steady accumulation of a pronounced and persistent neurologic deficit, a high rate of progression and high scores on the EDSS disability scale more than 6.5 points) were subsumed under the subgroup with the lack of efficacy (28 individuals). After transformation in the SPC, the most unfavorable variant of progression prevailed (21 patients); significantly less frequent were the recurrent (5 patients) and a combination of a steady and recurrent (2 patients) progression. The persistent lack of efficacy of the hormonal therapy in this subgroup of patients was most likely associated with the genetically determined low individual sensitivity to GC.

Therefore, the results of our study showed that the efficacy of GC therapy in SPC of MS is determined by the complex interaction of clinical indicators having the prognostic value, as well as by the number of the genetic factors, which require their further observation.


Keywords


multiple sclerosis; secondary-progressive course; pulse-therapy with glucocorticoids; treatment effectiveness

Full Text:

PDF

References


Shmidt, T. E., Yakhno, N. N. (2010). Rasseyannyy skleroz. Moscow: MEDpress-inform, 272.

Gusev, E. I., Boyko, A. N., Stolyarov, I. D. (2009). Rasseyannyy skleroz. Moscow: Real Taym, 296.

Shmidt, T. E. (2014). Lechenie i differentsialnyy diagnoz rasseyannogo skleroza i optikomielita (po materialam 29-go kongressa ECTRIMS). Nevrologicheskiy zhurnal, 19 (2), 53–62.

Sadiq, S. A., Simon, E. V., Puccio, L. M. (2010). Intrathecal methotrexate treatment in multiple sclerosis. Journal of Neurology, 257 (11), 1806–1811. doi: http://doi.org/10.1007/s00415-010-5614-4

Negreba, T. V. (2006). The course and prognosis of modern forms of multiple sclerosis. Ukrainskyi visnyk psykhonevrolohii, 14 (1 (46)), 44–46.

Negreba, T. V. (2009). Techenie i prognoz sovremennykh form rasseyannogo skleroza: Svіdotstvo pro reestratsіyu avtors'kogo prava na tvіr No. 30251 vіd 15.09.2009.

Voloshyna, N. P., Vasylovskyy, V. V., Negreba, T. V. et. al. (2013). Copyright certificate No. 47786 date 13.02.2013. New approaches to clinical diagnostics of various courses of multiple sclerosis and their differentiated therapy. Practical recommendations.

Vasilovskiy, V. V., Negreba, T. V., Voloshina, N. P., Chernenko, M. E. (2015). Effektivnost' mitoksantrona u bol'nykh s progredientnymi tipami techeniya rasseyannogo skleroza. Mіzhnarodniy nevrologіchniy zhurnal, 7 (77), 17–27.

Voloshyna, N. P., Vasylovskyy, V. V., Chernenko, M. Ye. (2008). The use of mitoxantrone in combination with cortexin for the treatment of progressive multiple sclerosis. Mezhdunarodnyiy nevrologicheskiy zhurnal, 6 (22), 13–16.

Voloshina, N. P., Negreba, T. V., Vasilovs'kiy, V. V. (2013). Novі pіdkhodi do klіnіchnoi dіagnostiki rіznikh tipіv perebіgu rozsіyanogo sklerozu і ikh diferentsіyovana terapіya. Praktichnі rekomendatsіi. Avtors'ke pravo na naukoviy tvіr No. 47786 vіd 13.02.2013.

Pozer, Ch. (1993). Multiple sclerosis. Zhurnal nevropatologii i psihiatrii im. S. S. Korsakova, 4, 77–78.

Voloshyna, N. P., Ehorkyna, O. V., Chernenko, M. E., Vorobeva, T. H. (2010). Sovremennie pryntsypi lechenyia rasseiannoho skleroza. Therapia. Ukrainskyi medychnyi visnyk, 2 (44), 31–33.

Alam, S. M., Kyriakides, T., Lawden, M., Newman, P. K. (1993). Methylprednisolone in multiple sclerosis: a comparison of oral with intravenous therapy at equivalent high dose. Journal of Neurology, Neurosurgery & Psychiatry, 56 (11), 1219–1220. doi: http://doi.org/10.1136/jnnp.56.11.1219

Vasilovskiy, V. V., Voloshina, N. P., Negreba, T. V., Levchenko, I. L., Chernenko, M. E., Tkacheva, T. N. (2014). Opyt primeneniya i effektivnost' endolyumbal'nogo vvedeniya glyukokortikoidov pri progredientnykh tipakh techeniya rasseyannogo skleroza. Ukrains'kiy nevrologіchniy zhurnal, 1 (30), 68–74.

Zavalishin, I. A., Peresadova, A. V. et. al. (2011). Voprosy diagnostiki i lecheniya rasseyannogo skleroza. Russkiy meditsinskiy zhurnal, 19 (7), 468–475.

Tompson, A., Polman, K., Holfeld, R. (Eds.) (2001). Multiple sclerosis: Clinical aspects and controversial issues. Saint Petersburg: Politehnika, 422.

Evtushenko, S. K., Derevyanko, I. N. (2006). Modern approaches to the treatment of multiple sclerosis: achievements, disappointments, hopes (2nd message). Mezhdunarodnyiy nevrologicheskiy zhurnal, 2 (6), 2–12.

Gusev, E. I., Zavalishin, I. A., Boyko, A. N. (2004). Multiple sclerosis and other demyelinating diseases. Moscow: Miklosh, 540.

Voloshyna, N. P., Vasylovskyy, V. V., Negreba, T. V., Levchenko, I. L., Tkacheva, Т. N. (2013). Clinical description of multiple sclerosis onsets in different courses, considering the current prognosis. Ukrainskyi nevrolohichnyi zhurnal, 4 (29), 7–13.

Voloshyna, N. P., Nehreba, T. V., Levchenko, I. L., Tkachova, T. M., Yehorkina, O. V. (2011). Prohnostychni kryterii pry riznykh typakh perebihu rozsiianoho sklerozu. Avtorske pravo na naukovyi tvir No. 39160 vid 14.07.2011.




DOI: http://dx.doi.org/10.21303/2504-5679.2018.00697

Refbacks

  • There are currently no refbacks.




Copyright (c) 2018 Vitaliy Vasylovskyy

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2504-5679 (Online), ISSN 2504-5660 (Print)