Safety Comparison of Conventional Versus Extended Infusion of Pulse Methylprednisolone in Multiple Sclerosis Exacerbation

Author(s): Haider Alabd, Lolwa Barakat, Bhagya Sree, Prem Chandra, Mohamed Khalil, Mohamed Elshafei

Objective: To determine the impact of Intravenous Methylprednisolone (IVMP) administration on the changes in vital signs (Heart Rate (HR), Systolic (SBP), Diastolic Blood Pressure (DBP), and serum potassium level in multiple sclerosis flare.

Design: retrospective review study conducted at Hamad General Hospital (HGH). All patients admitted in 2019-2020 with MS flare without any comorbidities were categorized into two groups depending on infusion rate. One group received a conventional IVMP dose over 30 minutes to one hour, while the second group received IVMP over an extended period) (four to six hours). After that, we assessed multiple readings of vital signs and potassium levels through steroid administration time to determine if there was an infusion-related significant difference in adverse events between both groups.

Methods: 74 adult patients with MS relapse admitted to Hamad General Hospital (HGH) and satisfied pre-specified inclusion criteria were invited to participate in the study.

Results: 74 patients with MS were included in the study; 61 patients (83.6%) received a methylprednisolone dose of 500 mg -1000 mg in a conventional infusion rate, while 12 patients (16.4%) received pulse steroids in an extended duration. Both groups had no significant difference in mean blood pressure before and after IVMP. There was a small but statistically significant increase in mean heart rate in the conventional group immediately after the first and second but not 3rd dose of IVMP compared to baseline 3.5± 8.9 and 4.85± 13.9 P < 0.003. There was a minimal non-significant increase in potassium level in the conventional group (P = 0.17), while there was a non-significant decrease in potassium level in the extended group (P=0.72).

Conclusion: IVMP is considered safe and effective in treating MS exacerbation regardless of intravenous infusion duration. There was no significant difference in vital signs among different infusion rates. However, there was a small but statistically significant increase in mean heart rate in the conventional group immediately after the first and second but not 3rd dose of IVMP compared to baseline. No significant difference was observed in potassium levels before and after IVMP. We, therefore, recommend restricting potassium level monitoring to patients with other risk factors of hypokalemia.