Chronotherapy using corticosteroids for multiple sclerosis relapses.
BACKGROUND
The activity of the immune system displays a circadian rhythm. In diseases characterised by aberrant immune activity, chronotherapy (a treatment regimen tailored to diurnal body rhythms) may increase the efficiency, safety and tolerability of drugs.


OBJECTIVE
To compare the outcomes of intravenous corticosteroid administration during the day or night, for treatment of acute multiple sclerosis relapses.


METHODS
17 patients with multiple sclerosis were included in the study. Clinical assessment of disability was performed at trial entry, and at days 7 and 30 from the initiation of treatment. Adverse events and preference of night-time versus daytime treatment were assessed at the end of the treatment course.


RESULTS
After night-time treatment, clinical recovery was significantly (p<0.001) enhanced and the mean number of side effects was significantly (p = 0.007) lower. Furthermore, most patients expressed a preference for night-time versus daytime treatment.


CONCLUSIONS
The study suggests a potential benefit for implementation of chronotherapy using steroid treatment for acute multiple sclerosis relapse, with implications for other immune-mediated disorders.
Glass-Marmor
Lea
L
Division of Neuroimmunology, Multiple Sclerosis Center, Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel.
Paperna
Tamar
T
Ben-Yosef
Yaara
Y
Miller
Ariel
A
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D019454:Chronotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D012008:Recurrence; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones