Venous Thrombosis in Multiple Sclerosis Patients after High-Dose Intravenous Methylprednisolone: The Preventive Effect of Enoxaparin

Aim. This study was designed to examine the possible role of high-dose intravenous methylprednisolone (IVMP) in the development of venous thrombosis (VT). The cerebral one anecdotally had been reported in patients with relapsing remitting multiple sclerosis (RRMS) in acute attacks and the possible preventive role of enoxaparin. Material and Methods. From a pool of 520 patients, 388 patients with definite RRMS who fulfilled entry characteristics were selected and randomly received either a 5-day course of daily 1 gr IVMP or the aforementioned plus 5 days of daily subcutaneous 40 units of enoxaparin according to a predefined protocol. Results. Mean age, gender ratio, mean relapse rate, and EDSS were similar in both groups of patients (P > 0.05). Finally, 366 patients remained in the study. Of 188 patients treated with IVMP with 855 relapses, 5 developed VT (0.37% per patient per year and 0.58% per each course of IVMP) within 3 to 15 days of starting therapy. None of the 178 patients who experienced 809 relapses who received IVMP plus enoxaparin developed such complications. Conclusion. The study implies that high-dose IVMP in MS exacerbation may increase the risk of VT and prophylactic anticoagulant treatment in this setting is warranted.

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Profile of cytokine gene polymorphisms in Iranian multiple sclerosis patients

Multiple Sclerosis Journal ◽

10.1177/1352458506070237 ◽

2007 ◽

Vol 13 (2) ◽

pp. 253-255 ◽

Cited By ~ 21

Author(s):

A Amirzargar ◽

F Khosravi ◽

S Dianat ◽

F Hushmand ◽

P Maryousef ◽

...

Keyword(s):

Multiple Sclerosis ◽

Gene Polymorphisms ◽

Cytokine Gene ◽

Immune Mediated ◽

Tnf Α ◽

Relapsing Remitting ◽

Cytokine Gene Polymorphisms ◽

Multiple Sclerosis Patients ◽

Relapsing Remitting Multiple Sclerosis

Background Cytokine gene polymorphisms have been extensively studied in association with different diseases. The role of cytokine gene polymorphisms in multiple sclerosis (MS), as a chronic immune-mediated neurodegenerative disease, has been previously reported. Materials and methods DNA samples were collected from 44 patients with relapsing-remitting multiple sclerosis (RRMS) and 140 unrelated healthy subjects. All participants in this study were matched for ethnicity. Cytokine gene SNPs were determined using the PCR-SSP method. Results and discussion We found no significant differences between MS patients and controls in most of the studied cytokine genes. Remarkable results were obtained for IL-2 GG —330 genotype (P = 0.06), IL-6 C —174 allele (P = 0.06), CG and GG genotypes (P < 0.001), and GG (P = 0.02) and CG (P < 0.001) haplotypes, and TNF-α A —238 allele (P < 0.001), GG (P = 0.003) and GA (P < 0.001) haplotypes. These results suggest that polymorphic variations of these pro-inflammatory cytokines play an important role in susceptibility to MS. Multiple Sclerosis 2007; 13: 253–255. http://msj.sagepub.com

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Safety and Tolerability in Relapsing-Remitting Multiple Sclerosis Patients Treated With High-Dose Subcutaneous Interferon-Beta by Rebiject Autoinjection Over a 1-Year Period

Clinical Neuropharmacology ◽

10.1097/wnf.0b013e3181571a8e ◽

2008 ◽

Vol 31 (3) ◽

pp. 167-172 ◽

Cited By ~ 16

Author(s):

Alessandra Lugaresi ◽

Valentina Durastanti ◽

Claudio Gasperini ◽

Marina Lai ◽

Carlo Pozzilli ◽

...

Keyword(s):

Multiple Sclerosis ◽

Interferon Beta ◽

High Dose ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Multiple Sclerosis Patients ◽

Relapsing Remitting Multiple Sclerosis

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Autoimmune hepatitis after high-dose intravenous methylprednisolone pulse in RR-MS

Open Medicine ◽

10.2478/s11536-007-0025-3 ◽

2007 ◽

Vol 2 (3) ◽

pp. 356-359

Author(s):

Reinhard Reuß ◽

Kerstin Retzlaff ◽

Sabine Vogel ◽

Folker Franke ◽

Patrick Oschmann

Keyword(s):

Multiple Sclerosis ◽

Lymphocytic Infiltration ◽

High Dose ◽

Intravenous Methylprednisolone ◽

Relapsing Remitting ◽

Liver Transaminases ◽

Rebound Phenomenon ◽

Intravenous Methylprednisolone Pulse ◽

Relapsing Remitting Multiple Sclerosis ◽

Glutamyl Transpeptidase

AbstractThree weeks after the administration of intravenous methylprednisolone therapy, a 42-year-old female patient suffering from relapsing-remitting multiple sclerosis (RR-MS) presented with a profound elevation of liver transaminases (GOT 485 U/l, GPT 1082 U/l, glutamyl transpeptidase 170 U/l). Liver biopsy revealed a profound, still active hepatitis with portal lymphocytic infiltration and fibrosis. Most likely, existing acute hepatitis was of autoimmune origin and emerged from an immune rebound phenomenon after immunosuppressive therapy.

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Effect of monthly intravenous cyclophosphamide in rapidly deteriorating multiple sclerosis patients resistant to conventional therapy

Multiple Sclerosis Journal ◽

10.1177/135245850100700309 ◽

2001 ◽

Vol 7 (3) ◽

pp. 185-188 ◽

Cited By ~ 51

Author(s):

Omar A Khan ◽

Marina Zvartau-Hind ◽

Christina Caon ◽

Moeen U Din ◽

Mickey Cochran ◽

...

Keyword(s):

Multiple Sclerosis ◽

Conventional Therapy ◽

Clinical Deterioration ◽

Intravenous Methylprednisolone ◽

Intravenous Cyclophosphamide ◽

Relapsing Remitting ◽

Methylprednisolone Treatment ◽

Multiple Sclerosis Patients ◽

Relapsing Remitting Multiple Sclerosis ◽

Clinical Worsening

Fourteen consecutive clinically definite relapsing-remitting multiple sclerosis (MS) patients were treated with monthly intravenous cyclophosphamide (CTX) for 6 months. All had experienced severe clinical deterioration during the 12 months prior to treatment with CTX despite treatment with conventional immunomodulating agents and intravenous methylprednisolone. Treatment with CTX led to improvement and neurologic stability within 6 months which was sustained for at least 18 months after the onset of treatment with CTX. Therapy with CTX was well tolerated. CTX may be of benefit in MS patients who experience rapid clinical worsening and are resistant to conventional therapy.

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