Methylprednisolone effect on brain volume and enhancing lesions in MS before and during IFN&bgr;-1b

ObjectiveTo determine the effect of IV methylprednisolone (IVMP) on brain fraction volume (BFV), contrast-enhancing (CE) lesions, and white matter lesion load (WMLL) in patients with relapsing-remitting MS treated for acute exacerbations. BackgroundMRI metrics of MS disease activity are being used as outcome measures in early phase treatment trials, however the short-term effects of IVMP treatment on cerebral atrophy are unknown. MethodsSerial monthly MRI were performed in 26 patients enrolled in a baseline vs treatment trial with interferon &bgr;-1b (IFN&bgr;-1b) who were followed for 3 months before and after IVMP. All 26 patients were evaluated while receiving IFN&bgr;-1b, and 12 patients were also studied during the baseline stage of the trial (NHx). Acute exacerbations were treated with IVMP (1 g/d) for 3 to 5 days. Precontrast and postcontrast T1-weighted and proton density T2-weighted fast spin-echo images were analyzed. ResultsFifty-six acute exacerbations were evaluated. For the 3 months before IVMP, there was no difference in WMLL or BFV compared to month IVMP was administered. There was a significant decrease in BFV at month 1 after IVMP in the IFN&bgr;-1b and NHx groups. Compared to the month IVMP was administered, there was a difference in the CE lesions for months −3 and −1 prior (p < 0.039) in NHx patients. Following IVMP, CE lesions decreased (p < 0.0004) for months 1, 2, and 3 in both groups, but there was no effect on WMLL. ConclusionsBFV and CE lesions were significantly decreased for 1 month (BFV) and 3 months (CE lesions) following IVMP. Therefore, MRI studies should be delayed by probably at least 2 months following IVMP to avoid a possible confounding steroid effect in a clinical trial.

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