Re-examining the effects of high-dose intravenous methylprednisolone for secondary progressive multiple sclerosis

Intravenous methylprednisolone (IVMP) is previously given to secondary progressive multiple sclerosis (SPMS) patients. This study aimed to re-examine the effects of IVMP in SPMS. Major electronic databases were searched for randomized controlled trials. Four randomized controlled trials were included. IVMP may be inferior to mitoxantrone (MTX) in terms of expanded disability status scale (EDSS) improvement. There was no significant difference in terms of EDSS reduction and magnetic resonance imaging (MRI) plaque reduction when IVMP + MTX were compared with MTX. There is no significant difference between IVMP and cyclophosphamide based on EDSS progression and relapse reduction. IVMP should not be routinely used as treatment for SPMS and is not recommended as an alternative treatment for SPMS. Secondary progressive multiple sclerosis (SPMS) is a subtype of multiple sclerosis that is associated with degeneration of the nervous system. It is a disabling condition and unlike the relapsing-remitting form of multiple sclerosis, the approved medicines for SPMS are fewer and not readily accessible in developing countries because of cost and availability. Thus, neurologists in these areas have fewer treatment options for SPMS. One of these is intravenous methylprednisolone (IVMP), which is an affordable drug. This study looked at the evidence about IVMP in SPMS. However, the evidences are few and do not support the use of IVMP in SPMS because of a lack of efficacy in reducing disability and abnormal findings in the magnetic resonance imaging.