Methylprednisolone Treatment, Patient Reported Tolerance and Efficacy

Background: The standard of care in treatment of multiple sclerosis relapses is to use intravenous corticosteroids (predominantly IntraVenous Methylprednisolone or IVMP).  Treatment is initiated to shorten the recovery time and decrease disability due to relapse. Beyond IVMP, the only FDA (Food and Drug Administration) approved therapy is subcutaneous or intramuscular ACTH (Acthar®).  ACTH is used as a second line agent largely because of the cost difference of standard therapy, approximately $500-$1000 for IVMP, versus over $30,000 for ACTH.  There is little guidance and literature on the proper use of the more expensive therapy, which would be appropriate in patients who are either non-responders or who have severe reactions to IV corticosteroids. 

Objectives: To survey our patient population in regard to their response and tolerance to the standard therapy, IVMP, in order to better quantify and evaluate the proper use of alternative acute relapse treatment with ACTH.

Methods: Over a 60 day period, all patients treated at our center were asked to fill out a questionnaire regarding their past experience with IVMP treatments.  They were surveyed on their perceived response to therapy and the side effects.

Results: 174 out of 207 patients surveyed had been treated with IVMP.  Among other results that will be reported, 58% reported mild to no side effects.  31% noted moderate side-effects and 11% noted severe side effects.  Only 5% of the entire sample described the side effects as intolerable.  Only 30% of the patients who noted severe side effects described the side effects as intolerable.  The most common side effects reported were sleep disturbance and mood alteration.  80% of all patients surveyed noted improvement with IVMP, while 12% noted no improvement and 8% noted worsening with IVMP therapy. 

Conclusions:

IVMP is a well tolerated and efficacious treatment for multiple sclerosis relapses.  Due to cost differences, ACTH will continue to be a second line agent.  However, our patient survey indicates ACTH should be considered in approximately 5% of patients with intolerable side effects. ACTH should also be considered in 10-20% of patients with lack of efficacy to IVMP.