Low-dose oral methotrexate in chronic progressive multiple sclerosis: analyses of serial MRIs.
We monitored 56 patients with chronic progressive multiple sclerosis (MS) who participated in a clinical trial of weekly, low-dose oral methotrexate with annual gadolinium-enhanced MRIs of the brain (Gd + MRI). Not of these patients had clinical exacerbations during the 8 months preceding study entry. We also monitored 35 of the patients with serial Gd + MRIs every 6 weeks for 6 months. We observed a treatment effect, measured by absolute change in T2-weighted total lesion area (T2W-TLA), in the cohort that completed 6-week scans. We found change in T2W-TLA in this cohort to be significantly related to sustained change in performance on the nine-hold peg test but not to sustained change on the Expanded Disability Status Scale. Gadolinium enhancement of lesions on 6-week and annual scans was uncommon. Prestudy exacerbation frequency appears to be an important consideration in designing future clinical trials in patients with secondary and primary progressive MS.
Goodkin
D E
DE
University of California, San Francisco/Mt. Zion Multiple Sclerosis Center 94115, USA.
Rudick
R A
RA
VanderBrug Medendorp
S
S
Daughtry
M M
MM
Van Dyke
C
C
D000284:Administration, Oral; D000328:Adult; D004311:Double-Blind Method; D006801:Humans; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000008:administration & dosage*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology*; D013997:Time Factors
D008727:Methotrexate