The effect of pulse methylprednisolone plus theophylline treatment on clinical, pulmonary and inflammatory markers in relapses of multiple sclerosis

Abstract

Objective:The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmo - nary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor NecrosisFactor (TNF)-alpha levels and clinical scores in MS relapses.Study Design:Double blind randomized controlled trial. Material and Methods:The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysisof TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IVtheophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alphaon the 5 thand 30 thdays of the treatment.Results:Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, numberof exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFTfindings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was foundto be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5 thday 2.4±1.6; 30 thday 2±1.7). There was no statisticallysignificant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed inthe placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation betweenthe clinical parameters, PFT and TNF-alpha level.Conclusion:There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbationssince it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.