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Abstract
Background: Multiple sclerosis (MS) is a relapsing, inflammatory, and demyelinating disease of central nervous system showing marked clinical heterogeneity. Many factors might influence the choice of relapse prevention drug, and treatment response varies among patients. Despite the enlargement of disease-modifying drugs for MS (MS-DMDs), some patients have been treated with corticosteroid and/or immunosuppressant (CS/IS).Objective: To clarify the radiological and laboratory features of MS treated with CS/IS for relapse prevention.Methods: Clinical records including radiological and laboratory findings, and drugs used for relapse prevention were reviewed retrospectively.Results: Out of 92 consecutive MS patients, 25 (27%) were treated with CS/IS. The followings were observed less frequently in patients treated with CS/IS than in those with MS-DMDs: three or more periventricular lesions, ovoid lesions, subcortical lesions, typical contrast-enhancing lesions, negative for serum autoantibodies, and positive for oligoclonal bands in the cerebrospinal fluid. Multiple logistic regression analysis revealed that the absence of typical contrast-enhancing lesions and positivity for serum autoantibodies were independent factors associated with CS/IS prescription (odds ratio 25.027 and 14.537, respectively).Conclusion: In this cohort of Japanese patients clinically diagnosed with MS, radiological and serological findings atypical of MS were observed more frequently in patients treated with CS/IS than in those with MS-DMDs as a part of MS therapy. The absence of contrast-enhancing lesions typical of MS and positivity for serum autoantibodies were independent factors strongly associated with CS/IS use.
Highlights
Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system (CNS) associated with demyelination and axonal damage [1]
Of the 125 patients, 33 were excluded from the analysis: 24 were seropositive for AQP4 antibody by the cell-based assay, three fulfilled seronegative neuromyelitis optica spectrum disorder (NMOSD) criteria [11], one was seropositive for myelin oligodendrocyte glycoprotein (MOG) antibody by the cell-based assay, and five were seropositive for other anti-neuronal antibodies by the cell-based assay (Figure 1)
The multiple logistic regression analysis revealed that the absence of nodular/open ring/ring contrast-enhancing lesions [odds ratio = 25.027 (1.559–401.821), p = 0.02] and positivity for serum autoantibodies [odds ratio = 14.537 (1.809–116.814), p = 0.01] were independent factors strongly associated with corticosteroid and/or immunosuppressant (CS/IS) use based on currently ongoing therapy
Summary
Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system (CNS) associated with demyelination and axonal damage [1]. Differentiation between MS and NMOSD has an important implication regarding patient management because patients respond differently to treatment, and some disease-modifying drugs for MS (MS-DMDs) are ineffective or exacerbate NMOSD [2]. Experts recommend immunosuppression as first-choice treatment for most MS/NMOSD-overlap patients, and some MS patients [9]. To clarify the most important clinical factors related to corticosteroid and/or immunosuppressant (CS/IS) use, we compared the radiological and laboratory findings between MS patients treated with CS/IS and MS-DMDs. Multiple sclerosis (MS) is a relapsing, inflammatory, and demyelinating disease of central nervous system showing marked clinical heterogeneity. Despite the enlargement of disease-modifying drugs for MS (MS-DMDs), some patients have been treated with corticosteroid and/or immunosuppressant (CS/IS)
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