Effectiveness Of Different Dose, Courses And Routes Methylprednisolone In The Treatment Of CIS: A Systematic Review

Objective To evaluate the effectiveness and safety of different dose, courses and routesMethylprednisolone(MP) in the treatment of clinically isolated syndrome(CIS).Methods We searched The Cochrane Library (Issue4,2011), Medline (1950to2011),Embase (1980to2011), CBMdisc (1978to2011), CNKI (1979to2011), VIP (1989to2011),Wan fang Database (1978to2011), CMCA (1994to2011) by electronic database and relevantjournals such as Journal of Clinical Neurology, Chinese Journal of Neurology, Chinese Journalof Neuroimmunology and Neurology, Journal of Apoplexy and Nervous Diseases, ChineseJournal of Clinical Neurosciences etc. by manual searching to collect all world RCTs andquasi-RCTs of MP for patients with CIS. The quality of included studies was assessed accordingto the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventionsand data were extracted by two reviewers independently. We made meta-analysis, quantitativequalitative comprehensive analysis, funnel plot analysis for the study results. In themeta-analysis, fixed or random potency model was chosen according to the heterogeneity. Metaanalysis was conducted by The Cochrane Collaboration's RevMan5.0software. Estimated theevaluation index by95%confidence interval and made.=0.05for the size of test.Results The results of Meta-analysis showed that:(1) The improvement of visual functionduring the study:7The improvement of visual function in the MP group was higher than that inthe control group after one weeks and months(RR=1.50,95%CI(1.03,2.17), P=0.03),(RR=1.30,95%CI(1.04,1.62), P=0.02).8Comparing the improvement of visual function of MP groupwith the control group after six months and one years(RR=1.10,95%CI(0.96,1.27), P=0.19),(RR=1.02,95%CI(0.94,1.09), P=0.67), it have no statistically significant.(2) The improvementof visual function with different dose:7The dose13g: The improvement of visual function inthe MP group was higher than that in the control group after one weeks and months(RR=1.55,95%CI(1.02,2.37), P=0.04),(RR=1.33,95%CI(1.02,2.74), P=0.03). Comparing the improvementof visual function of MP group with the control group after six months and one years(RR=1.12,95%CI(0.95,1.32), P=0.16),(RR=1.01,95%CI(0.94,1.09), P=0.81),it is no statisticallysignificant.8The dose3g: Comparing the improvement of visual function of MP group withthe control group after one weeks, one months, six months and one years(RR=1.21,95%CI(0.76è1.92), P=0.42),(RR=1.25,95%CI(0.88,1.78), P=0.21),(RR=1.04,95%CI(0.88,1.24, P=0.65),(RR=0.87,95%CI(0.75,1.02), P=0.08), it have no statistically significant.(3) The improvementof visual function with different route:7The route of3days: The improvement of visual function in the MP group was higher than that in the control group after one weeks and months(RR=1.61,95%CI(1.03,2.50), P=0.03),(RR=1.35,95%CI(1.02,1.79), P=0.03). Comparing theimprovement of visual function of MP group with the control group after six months and oneyears(RR=1.12,95%CI(0.94,1.33), P=0.19),(RR=1.00,95%CI(0.93,1.07), P=0.96), it have nostatistically significant.8The route ú2weeks: Comparing the improvement of visual functionof MP group with the control group after one weeks, one months, six months and oneyears(RR=1.21,95%CI(0.78,1.87), P=0.39),(RR=1.18,95%CI(0.90,1.56), P=0.24),(RR=1.06,95%CI(0.90,1.25), P=0.46),(RR=0.88,95%CI(0.76,1.02), P=0.10), it have no statisticallysignificant.(4) The improvement of visual function with different ways:7Intravenous injection:The improvement of visual function in the MP group was higher than that in the control groupafter one weeks and months(RR=1.61,95%CI(1.03,2.50), P=0.03),(RR=1.35,95%CI(1.02,1.79),P=0.03). Comparing the improvement of visual function improvement of MP group with thecontrol group after six months and one years(RR=1.12,95%CI(0.94,1.33), P=0.19),(RR=1.00,95%CI(0.93,1.07), P=0.96), it have no statistically significant.8Oral: Comparing theimprovement of visual function of MP group with the control group after one weeks, one months,six months and one years(RR=1.16,95%CI(0.74,1.81), P=0.51),(RR=1.18,95%CI(0.90,1.56),P=0.24),(RR=1.05,95%CI(0.89,1.25), P=0.53),(RR=0.88,95%CI(0.76,1.01), P=0.07), it haveno statistically significant.(5)The occurrence rate of CDMS:7Comparing the incidence ofCDMS of MP group with the control group after one and two years, it have no statisticallysignificant. however, the incidence of CDMS can reduce in clinical.8Comparing the incidenceof CDMS of MP group with the control group after three and five years, it have no statisticallysignificant.(6)Safety evaluation: The reports of serious adverse effects were rare during thetreatment and the follow up, adverse reactions mainly include acute depression, acutepancreatitis, sleep disorder, mood changes, gastrointestinal discomfort, facial flushing, gainweight, hyperglycemia, hyperlipidemia, hypertension, acne, edema, musculoskeletal pain.Conclusion IVMP is therefore effective in accelerating short-term recovery of visualfunction in patients with CIS. The incidence of CDMS have significantly reduce with MP after1and2years. The adverse reactions include acute depression, acute pancreatitis, sleep disorder,mood changes, gastrointestinal discomfort, facial flushing, gain weight, hyperglycemia, hyperlip-idemia, hypertension, acne, edema, musculoskeletal pain. As the evidence obtained is not strongenough owing to the studies is less and the sample size is smaller, so the above conclusions stillneed high quality of randomized controlled trials to confirm.