DOI: 10.1007/s13311-017-0533-z Pages: 1-11
Article Type: Original Article

Effectiveness of Daily Prednisolone to Slow Progression of Human T-Lymphotropic Virus Type 1-Associated Myelopathy/Tropical Spastic Paraparesis: A Multicenter Retrospective Cohort Study

1. St. Marianna University School of Medicine, Department of Rare Diseases Research, Institute of Medical Science

2. Kagoshima University Graduate School of Medical and Dental Sciences, Department of Neurology and Geriatrics

3. Kyoto Prefectural University of Medicine, Department of Neurology, North Medical Center

4. Hokkaido Medical Center, Department of Clinical Research

5. Ehime University Graduate School of Medicine, Department of Neurology and Clinical Pharmacology

6. Nagasaki International University, Department of Social Work, Faculty of Human and Social Studies

7. Kansai Medical University, Department of Microbiology

8. St. Marianna University School of Medicine, Medical Informatics

Correspondence to:
Yoshihisa Yamano
Email: yyamano@marianna-u.ac.jp

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Abstract

Millions of people are infected with human T-lymphotropic virus type 1 (HTLV-1) worldwide; notable endemic areas include Brazil, the Caribbean islands, Iran, and Japan. A small number of those infected develop the progressive neurodegenerative disease HTLV-1-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP), which is characterized by chronic spinal cord inflammation and accompanying myelopathic symptoms. The corticosteroid prednisolone (PSL) is a classic treatment for HAM/TSP, yet its effectiveness remains controversial owing to insufficient and conflicting studies. We conducted a multicenter retrospective study using data collected by physicians monitoring patients with HAM/TSP at 7 hospitals throughout Japan. The Osame Motor Disability Score (OMDS) was used to evaluate 57 patients treated with low-dose PSL (mean 4.8 mg/day) versus 29 untreated patients. Roughly half of the evaluations spanned < 3 years (Short-Term) and half > 3 years (Long-Term), with a mean of 3.4 years. While the OMDS of most untreated patients remained unchanged in the Short-Term (87%) and worsened in the Long-Term (79%), most treated patients improved in the Short-Term (52%) and remained unchanged or improved in the Long-Term (68%). Overall, the mean change in OMDS per year was –0.13 in the Steroids group and +0.12 in the Untreated group (p < 0.01). This study addressed the effectiveness of PSL for HAM/TSP in 3 novel ways: 1) continuous low-dose administration; 2) comparison with an untreated group; and 3) Long-Term evaluation. These findings provide robust evidence supporting PSL maintenance therapy for HAM/TSP.

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  • Online: May 23, 2017

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