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.
Aim: 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.
- EDSS, Expanded Disability Status Scale
- IVMP, intravenous methylprednisolone
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Funding: This work was supported by funds provided by the Carmel Medical Center, The Rappaport Institute for Research in the Medical Sciences and the Technion–Israel Institute of Technology, Haifa, Israel.
Competing interests: None.
Published Online First 20 October 2006
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