Predicting response to steroids

Rakusa M, Cano SJ, Porter B, Riazi A, Thompson AJ, Chataway J, Hardy TA. A Predictive Model for Corticosteroid Response in Individual Patients with MS Relapses. PLoS One. 2015 Mar 18;10(3):e0120829.

MATERIALS AND METHODS:We analysed individual patient randomised controlled trial data (n=98) based on age, gender, baseline disability scores [physician-observed: expanded disability status scale (EDSS) and patient reported: multiple sclerosis impact scale 29 (MSIS-29)], and the time intervals between symptom onset or referral and treatment.
RESULTS:Based on two a priori selected cut-off points (improvement in EDSS ≥ 0.5 and ≥ 1.0), we found that variables which predicted better response to corticosteroids after 6 weeks were younger age and lower MSIS-29 physical score at the time of relapse .
CONCLUSIONS:This pilot study suggests two clinical variables which may predict the majority of the response to corticosteroid treatment in patients undergoing an MS relapse. The study is limited in being able to clearly distinguish factors associated with treatment response or spontaneous recovery and needs to be replicated in a larger prospective study.

The Multiple Sclerosis Impact Scale (MSIS-29) is a measure of the physical and psychological impact of MS from the patient’s perspective (a copy of the MSIS-29 can be found click here). Low scores in the MSIS-29 and youth predicted the best response to steroids. This group of people are more likely to have a bigger "neurological compensatory reserve" and thus tolerate neurological insults better..

During the relapse an MSers is subject to the effects of the inflammatory penumbra. If  evidence of benefit occurs in the optic neuritis trial, it will suggest that there are additional ways to limit nerve damage as a consequence of the relapse over and above that caused by steroid use.

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