A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations Miller D M, Weinstock-Guttman B, Bethoux F, Lee J C, Beck G, Block V, Durelli L, LaMantia L, Barnes D, Sellebjerg F, Rudick R A Authors' objectives To assess methylprednisolone (MP) at different doses, and in comparison with other steroid products, in the treatment of multiple sclerosis exacerbations. Searching MEDLINE was searched from 1981 to 1998, and EMBASE from 1980 to 1998, combining 'Multiple Sclerosis' (as an index term) with 'Methylprednisolone' (either as an index term or in 'authors, title or abstract'). The references of identified articles and recent review articles were also examined. No restrictions on publication language were specified. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) where treatment was initiated within 8 weeks of relapse onset, and EDSS data had been collected within the first 4 weeks after treatment and at similarly spaced intervals thereafter, were included. Specific interventions included in the review MP in high doses (HD) of at least 500 mg/day for a minimum of 3 days, and low doses (LD) of at most 48 mg/day (equivalent to 60 mg prednisolone). These were compared with other glucocorticosteroid products (administered at similar dosage rates to those of MP), placebo, or no treatment. Participants included in the review Patients with multiple sclerosis were included. Outcomes assessed in the review Change in Kurtzke Expanded Disability Status Score (EDSS) were assessed. How were decisions on the relevance of primary studies made? Two authors independently selected the papers for inclusion using a structured evaluation process. Any disagreements were resolved by consensus. Assessment of study quality Full article reviews were only conducted for studies with a randomised controlled design. No other formal assessment of validity was performed. Two authors independently reviewed the papers for acceptable study design, and any disagreements were resolved by consensus. Data extraction Two authors independently performed the data extraction using a structured evaluation process. Any disagreements were resolved by consensus. Data were extracted for the categories of study identification, type of comparison, treatments and dose, dose of active treatment, and EDSS assessment. Original data were requested from the authors of the included studies. Methods of synthesis How were the studies combined? Effects sizes (ES), the differences between the means of EDSS scores, were calculated using both fixed-effect and Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 3