DOI: https://doi.org/10.22141/2224-0713.4.98.2018.139421

Comparative efficacy of hormone pulse therapy in relapsing and secondary progressive multiple sclerosis with different prognosis. Message 1. Тhe efficacy of hormone pulse therapy during onset and at the relapse phase in relapsing and secondary progressive

N.P. Voloshyna, T.V. Negreba, V.V. Vasylovsky, K.O. Pisotska, T.N. Tkacheva, M.Ye. Chernenko

Abstract


We have studied the efficacy of pulse therapy with glucocorticoids (GCT) during onset and at the relapse phase in 98 patients with multiple sclerosis (MS): 28 of them (24 women and 4 men) with uncertain prognosis in relapsing course (RC) — group 1; 30 individuals (21 women and 9 men) with uncertain prognosis in secondary progressive course (SPC) — group 2, and 40 patients (36 women and 4 men) with unfavo-rable prognosis in SPC — group 3. We have recorded the following clinical indicators: the patient’s age, the duration of disease, the age of onset, the severity of onsets, the duration of remission after onset, the duration of relapse phase, the severity and total number of relapses in relapse phase, the average incidence of relapses and duration of remissions in relapse phase, and the degree of disability according to the Expanded Disability Status Scale (EDSS). We have conducted 287 sessions of GCT: with uncertain prognosis for RC — 98 (onsets — 9, relapse phase — 89), with uncertain prognosis for SPC — 99 (onsets — 3, relapse phase — 96), with unfavorable prognosis for SPC — 90 (onsets — 8, relapse phase — 82). We have defined the clinical and diagnostic criteria to evaluate treatment effectiveness, they were as follows: the dynamics of regression of neurological symptoms under the influence of the first course of GCT at the stage of onset; the comparative evaluation of remission duration after the onset with and without administration of GCT; the mean incidence of relapses during the repeated courses of GCT at relapse phase; the duration of relapse phase depending on the remission duration after the first course of GCT. In the group of patients with uncertain prognosis for RC, we have additionally taken into consideration the duration of remissions after the last course of GCT; the rate of progression at relapse phase and also the dynamics of disability score according to the EDSS after the first and before the last course of GCT. The study showed that during treatment, the clinical indicators characte-rizing the course of onsets and relapse phase undergo a complex systemic reorganization, depending on the type of course and the nature of the prognosis. Hormone therapy was most effective with uncertain prognosis in RC. There were identified two categories of treatment efficacy in this group: high (17 patients) and moderate (11 patients). We have determined the positive dynamics of most clinical indicators as the criteria for treatment effectiveness. They manifested by a rapid and complete regression of neurological symptoms in onsets, increase of remission duration after the onset, decrease in the incidence and severity of relapses in relapse phase, increase in the number of patients with average incidence of relapses
< 1.0, persistent minimal neurological deficit, low rate of progression, inconsistent negative dynamics of scores on the EDSS scale. As a result of this reorganization, the duration of relapse phase was extended, and the immediate risk of RC transformation into SPC was prevented.


Keywords


multiple sclerosis; course of the disease; prognosis; pulse therapy with glucocorticoids; treatment efficacy

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