文档介绍：糖皮质激素在神经科临床上的应用
浙二神经科:都爱莲
MS
Steroid especially methylprednisolone is the first line medication for MS.
The results do not justify routine application of IVIg as add-on therapy to IV methylprednisolone in the treatment of acute multiple sclerosis attacks. (Randomized Controlled Trial,Neurology. 2004 ; Mult Scler. 2004 )
high-dose intravenous methylprednisolone(500mg-1g*3-5days)
Lancet , 1997
Of the 80 patients recruited, 38 receive intravenous and 42 oral steroids . Clinical measurements at entry and at 1 week, 4 weeks, 12 weeks, and 24 weeks included Kurtzke's expanded disability status scale (EDSS).
The oral regimen was 48 mg methylprednisolone a day,*7 days, followed by 24 mg * 7 days, and finally 12 mg * 7 days.
The intravenous regimen consisted of 1 g methylprednisolone a day in 100 mL 5% dextrose given over 30 min on 3 consecutive days.
intravenous vs oral steroids
The median duration of the onset phase was 13 days in the intravenous group and in the oral group. The delay from cessation of worsening for 23 (61% intravenous) and 25 (60% oral).
After randomisation the clinical course of each group was similar. No difference in recovery (measured by the three indices) between the two treatment groups emerged at any stage of the trial.
intravenous vs oral steroids
Lancet , 1997
pared the total amount of steroid absorbed after 1250 mg oral prednisone vs 1 g IVMP in 16 patients with multiple sclerosis (MS). At 24 hours, the mean area under the concentration-time curve (AUC), the ponent of bioavailability, did not differ between groups (p = ). This suggests that the amount of absorbed corticosteroid is similar after either steroid at these doses.
intravenous vs oral steroids
Neurology. 2004
Since our study did not show any clear advantage of the intravenous regime we conclude that it is preferable to prescribe oral rather than intravenous steroids for acute relapses in MS for reasons of patient convenience, safety, and cost.
Lancet , 19