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High dose steroid therapy is commonly used to treat MS exacerbations and is known to elevate BP and glucose.
There are considerable variations in clinical practice in the monitoring of glucose and BP during steroid therapy.
An “Expert Opinion Paper” published in 2008 by the Clinical Advisory Board of the National Multiple Sclerosis Society notes that “many aspects of steroid management are not evidence based” and suggests the “clinician's best medical judgement” should be used on an individual basis to guide IV MP (Methylprednisolone) treatment. The risk of adverse outcomes is felt to be small in relapsing remitting patients, as most are young with few comorbidities. It is recommended that daily glucose testing be performed on non diabetic patients as rare diabetic ketoacidosis has developed in non diabetics treated with corticosteroids. Patients with known co-morbidities should be “monitored closely”.
Objectives: Determine if clinically significant changes in glucose and BP occur in MS out patients treated with IV MP.
Methods:
This retrospective cohort study examined data extracted from the medical record of a consecutive series of outpatients treated with a daily single infusion of IV MP at Winthrop's Comprehensive MS Care Center between January 1 and June 30, 2012. The mean (± standard deviation) serum glucose (mg/dl) and BP (mmHg), determined prior to infusion on the first day and last day of steroid therapy, were compared using the paired t-test. An oral taper was not administered.
Patients with known diabetes, poorly controlled hypertension or unstable psychiatric status were excluded.
The measurements were obtained at different times of day and are not fasting values.
Results:
Subjects (n=18) were 37.6 ± 13.0 years of age on average (range: 20 to 60 years); 72.2% were female. The mean infusions of daily 1 gm IVMP were 2.6 (± 0.7) (range: 1 to 4 doses).
The mean random first/last treatment day glucose values (mg/dL)were 96.5 ± 11.9/108.4 ± 21.8; p <0.01. The highest was 215, therapy was discontinued.
The mean first/last treatment day systolic BP (mm/hg) values were 116.3 ± 11.3/120.3 ± 11.3; p=.03. The highest was 180, therapy was discontinued.
Conclusions:
This pilot study found 11% (2/18) of MS out patients, who did not have other comorbidities, required a cessation of IV MP therapy because of elevated glucose or BP.
Although the mean increases in glucose and BP were modest after IV steroid treatment for MS exacerbations (12.3% increase in serum glucose levels and a 3% increase in systolic BP), 2 clinically significant outlier elevations occurred requiring cessation of therapy.
On the basis of this pilot study we recommend daily glucose and BP monitoring in ambulatory MS patients without known comorbidities treated with IVMP. A larger study is needed to confirm these preliminary results.