A Systematic Review On The Treatment Of Multiple Slerosis By Methylprednisolone And Ocrelizumab

Objective:The aim of the first study is to compare the efficacy and safety about Oral methylprednisolone?MP?and Intravenous methylprednisolone in the acute treatment of multiple sclerosis?MS?.The purpose of the second study is to evaluate the efficacy and safety of Ocrelizumab in the remittent treatment of multiple sclerosis?MS?patients by a meta-analysis.Methods:We respectively searched the English data base,such as PubMed,EMbase,the Cochrane Library and the Chinese data base,like CNKI,WanFang Database,CBM and so on from inception to January 2018,to collect randomized controlled trials?RCTs?about the treatment of MS through Oral MP and intravenous MP by using the keywords“multiple sclerosis”,“MS”,“methylprednisolone”,“corticosteroids”,“MP”,“Oral”,“intravenous”,“randomizedcontrolled trial”and“randomized”.on the other hand,we using the keywords“multiple sclerosis”,“MS”,“Ocrelizumab”“randomized controlled trial”and“randomized”to complete the searching of second study.The Language is limited to Chinese and English.According to the inclusion criteria,two reviewers independently selected the articles,obtained the target literature and extracted the data.Finally We assessed the risk of bias of the included studies.Meta-analysis was performed by using RevMan 5.3 software.Results:the first study have Five RCTs with a total of 402 patients were selected.?1?efficacy evaluation:Compared to the IVMP,the EDSS score in 1 week?[OR=0.68,95%CI?0.29,1.60?,P=0.38]?,4 week?[OR=-0.99,95%CI?0.59,1.66?,P=0.98]?,12 week?[OR=-1.14,95%CI?0.33,3.95?,P=0.83]?and 24 week?[OR=1.01,95%CI?0.49,2.09?,P=0.98]?showed no significant difference without exception.and the number of gadolinium-enhancing lesions?OR=1.47,95%CI?0.60,3.63?,P=0.40,?also had no significant difference.?2?safety evaluation:There was no serious adverse events in each studies,compared to IVMP,in the main adverse events such as epigastric pain?OR=1.07,95%CI=[0.66,1.72],P=0.79?,dysgeusia?Metallic taste??OR=1.06,95%CI=[0.61,1.85],P=0.83?,anxiety?OR=1.11,95%CI=[0.68,1.81],P=0.69?,nausea?OR=0.87,95%CI=[0.51,1.49],P=0.62?,diarrhea?OR=1.38,95%CI=[0.71,2.66],P=0.34?,palpitation?OR=1.47,95%CI=[0.86,2.52],P=0.16?,headache?OR=1.59,95%CI=[0.93,2.71],P=0.09?and rash?OR=1.01,95%CI=[0.60,1.71],P=0.96?showed no significant difference,but in insomnia?OR=2.09,95%CI=[1.22,3.59],P=0.007?,the oral MP are more likely to have insomnia.Study 2 have Two RCTs with a total of 1820 patients were selected,The Ocrelizumab group had 937 people,and the interferon group had 883 people.Meta-analysis results indicated that:?1?in The effectiveness,Whether in the number of new T₂-hyperintense lesions?or=0.39,95%CI=[0.32,0.48],P<0.00001?and the number of gadolinium-enhancing lesions?odds ratio?or?=0.21,95%Confidence interval?CI?=[0.16,0.27],P<0.00001?or in the proportion of patients who had at least one relapse of MS?or=0.45,95%CI=[0.36,0,58],P<0.00001?and the cumulative probability of sustained disability?or=0.63,95%CI=[0.45,0.89],P=0.01?,All showed that the Ocrelizumab was more effective than interferon,and the difference was statistically significant.?2?in the security,the result showed that there are no significant differences between Ocrelizumab and Interferon in the general adverse events?or=1.06,95%CI=[0.84,1.34],P=0.61?,serious adverse events?or=0.79,95%CI=[0.56.1.12],P=0.18?and tomours?or=2.01,95%CI=[0.37,10.99],P=0.42?,but compare with Interferon,Ocrelizumab increase the frequency of infection?or=1.31,95%CI=[1.09,1.58],P=0.004?and infusion-related reaction?or=4.92,95%CI=[3.74,6.46],P<0.00001?.Conclusions:The first Study showed that methylprednisolone as an first-line regimens in MS,There was no significant difference in efficacy and safety between oral MP and intravenous MP.The second Study show that compare with Interferon,Ocrelizumab is effective and safe in the remittent treatment for MS.However,long-term efficacy and safety are still needed a large number of multicenter,double-blind,randomized controlled trials to demonstrate.