Home > Journals > Gazzetta Medica Italiana Archivio per le Scienze Mediche > Past Issues > Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 March;179(3) > Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 March;179(3):177-81

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as

 

REVIEW   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 March;179(3):177-81

DOI: 10.23736/S0393-3660.19.04109-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The evaluation of methylprednisolone therapy related mortality in patients with acute spinal cord injuries: a systematic review

Ghaffar SHOKOUHI 1, Homayoun SADEGHI 2, Sedra MOHAMMADI 3, Sina DINDARIAN 3, Fariba PASHAZADE 4, Hozan MOHAMMADI 5

1 Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3 Urmia Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran; 4 Evidence Based Medicine Center, Medical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran; 5 Tabriz Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran



INTRODUCTION: One of the medicines that recently introduced into the SCI treatments’ category with massive propaganda after the National Acute Spinal Cord Studies (NASCIS I, II, III), is Methylprednisolone (MP). But, the lack of transparency in the method of work and reporting of the results was led to disputes. The purpose of this study is to obtain a comprehensive conclusion about the efficacy or lack of effectiveness of Methylprednisolone in the recovery of SCI patients.
EVIDENCE ACQUISITION: A comprehensive search was undertaken in the electronic resources with consideration of the provisions contained in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). After identifying the search keywords as “Methylprednisolone”, “Spinal Cord Injury,” “Acute OR Traumatic,” the search was conducted without any limitation at the original date of these electronic resources until 1/8/2018. All studies published in English were included in the study.
EVIDENCE SYNTHESIS: In the Bracken study, statistically significant complications were pneumonia and severe sepsis in a 6-week follow-up of 48-hour methylprednisolone group while in the Pointillart study, hyperglycemia was the only complication that had a statistically significant difference in favor of groups with the methylprednisolone regimen. According to the Bracken study, in the 24M group 5.42%, in the 48M group 7.18% and in the 48T group 6.02% of the patients, totally 31 case of 499 patients (6.21%) and in the Pointillart study, 5 case of 106 patients (4.71%) died, which is relatively high rate of death, whereas the effect of this treatment is not accepted yet.
CONCLUSIONS: We can support the results of Bracken studies neither in NASCIS II nor in NASCIS III. The conclusion of the Pointillart study is evidence-based and supportable. Due to the failure of NASCIS studies to obtain the FDA’s approval, the results of the Pointillart study on the rejection of methylprednisolone effect and the reported complications, the use of methylprednisolone in ASCI patients cannot be considered as an evidence-based and defensible practice.


KEY WORDS: Spinal cord injuries; Methylprednisolone; Mortality

top of page