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.
University of California, San Francisco/Mt. Zion Multiple Sclerosis Center 94115, USA.
D E
DE
Goodkin
R A
RA
Rudick
S
S
VanderBrug Medendorp
M M
MM
Daughtry
C
C
Van Dyke
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