The Adverse Effects of High-dose Corticosteroids with Early and Late Severe Morbidity in the Treatment of Patients with Multiple Sclerosis: Long-term Observation Results/Multipl Skleroz Hastalarinin Atak Tedavisinde Yuksek Doz Kortikosteroid Kullaniminin Erken ve Gec Donem Agir Morbiditeye Yol Acan Yan Etkileri: Uzun Donem Gozlem Sonuclari

Objective: Intravenous methylprednisolone (IVMP) is the most commonly used emergency treatment for multiple sclerosis (MS) attacks and the risk of adverse effects is high due to frequent use. The aim of our study was to investigate the relationship between adverse effects that can lead to severe morbidity and possible pharmaceutic and/or physiologic causes. Materials and Methods: This study included patients with clinically definite MS who underwent IVMP treatment between 2010-2018. The corticosteroid treatment dose and duration, demographic characteristics, laboratory findings and adverse effect profiles of the patients were examined. Results: The medical records of 390 patients (F/M=294/96) with follow-up were evaluated retrospectively. Eleven (F/M = 8/3) patients who developed severe complications after IVMP were detected. The drug infusion was ceased in two patients due to severe allergic reactions or tachyarrhythmia. One patient with severe tachycardia and two patients with corticosteroid-induced allergy received IVMP therapy along with alternative treatment and observation methods. In nine patients, avascular bone necrosis (AVN) developed after the treatment. AVN was multifocal in six patients and monofocal in three patients. The most frequently affected localization was the femoral head (six patients), followed by the tibia and talus. Only one patient had a high and repeated-dose (42 g total) drug use. Two patients received single-dose IVMP treatment. Conclusion: In our study, the treatment-related complications of patients diagnosed as having clinical definite MS and receiving IVMP were defined and it was thought that they might not be related to drug dose and duration. Keywords: Avascular bone necrosis, corticosteroids, multiple sclerosis, adverse effect Amac: Intravenoz metilprednizolon (IVMP) tedavisi multipl skleroz (MS) ataklarinda en sik basvurulan acil tedavi seklidir ve sik kullanimi nedeniyle yan etki gorulme riski yuksektir. Calismamizin amaci agir morbiditeye yol acabilecek yan etkilerin olasi farmasotik ve/veya fizyolojik sebeplerle iliskisini incelemektir. Gerec ve Yontem: Bu calismaya 2010-2018 tarihleri arasinda klinik kesin MS (KKMS) tanisi ile takip edilen ve IVMP tedavisi alan hastalar dahil edildi. Hastalarin kortikosteroid (KS) tedavi doz ve sireleri, demografik ozellikleri, laboratuvar bulgulari ve yan etki profilleri incelendi. Bulgular: Takipleri surdurulen 390 (K/E = 294/96) hastanin dosyasi retrospektif olarak incelendi. IV