Glucocorticoid (GC) pulse therapy is used for Multiple Sclerosis (MS) relapse treatment. At the same time GC resistance often mandates timely introduction of plasma exchange (PLEX). There are yet no well established predictors for the GC dose needed to treat MS relapses.
The aim of this study is to establish a predictive model basing on clinical data to support clinicians in estimating the maximum GC dose above which no additional therapeutic value can be expected.
We retrospectively screened clinical registries at University Hospital Bern and Ruhr University Hospital Bochum for MS patients treated with GC. We performed a multivariate regression analysis with GC dose as dependent variable and Vitamin D (25D) level, sex, age, expanded disability status scale (EDSS), contrast enhancement on cranial and/or spinal MRI, immunotherapy and clinical involvement of optic nerve as independent variables.
In this explorative cohort, 113 MS patients were included (Bern/Bochum: n = 63/47). Our model in total significantly predicted GC dose, however within the independent variables only 25D serum concentration and presence of optic neuritis were independent predictors of the GC dose needed to treat the present MS relapse ([25D]: -25.95 (95% CI: -47.40 - -4.49), p=0.018; optic neuritis: 2040.51 (95% CI: 584.64 – 3496.36), p=0.006).
Considering that GC dosing appears to be individual with several response-influencing factors, we established a predictive model, which supports clinicians to estimate GC dose needed to treat MS relapses. A second validation cohort is needed to proof our analysis.