Effect of Methylprednisolone and Interferon Treatment on Blood Vitamin B12, Folic Acid and Homocysteine Levels in Patients with Multiple Sclerosis

Abstract

Changes in blood homocysteine, vitamin B12 and folic acid levels have been reported during multiple sclerosis (MS) and treatment period; however, the exact mechanism has not been enlightened. We investigated the changes of serum B12, folic acid, and plasma homocysteine levels before and after high-dose IV methylprednisolone treatment and after interferon-β treatment in patients admitted with an acute attack of MS.31 patients followed for clinically definite MS (8 male, 23 female) and 10 control individuals were included in the study. 20 patients were admitted with an acute attack and were administered 1000 mg/day methylprednisolone for 7 days. 27 patients started interferon-β treatment. Serum B12, folic acid, and plasma Homocysteine levels measured before and after the 1 month after high dose steroid treatment and after 3-month interferon-β treatment were compared with pre-treatment levels and healthy controls. Baseline B12 levels were lower in patients with MS than in healthy controls, which is consistent with previous findings. Both methylprednisolone and interferon-β treatments increased serum B12 and folic acid levels compared with baseline; however, only the increase following methylprednisolone treatment was statistically significant.In our study, elevated B12 and folic acid levels and decreasing of homocysteine levels without reaching statistical significance following methylprednisolone have caused different debates.

Keywords

• multiple sclerosis,methylprednisolone,interferon-beta,vitamin B12,folic acid,homocysteine

Multipl Skleroz Hastalarında Metilprednizolon ve İnterferon Tedavisinin Kan Vitamin B12, Folik Asid ve Homosistein Düzeyleri Üzerine Etkisi

Öz

Multipl Skleroz (MS) hastalığının seyrinde ve tedavi sürecinde homosistein, vitamin B12 ve folik asit düzeylerindeki değişiklikler bildirilmiş ancak tam mekanizması aydınlatılamamıştır. Çalışmamızda, akut atak ile başvuran hastalarda yüksek doz metilprednizolon tedavisi öncesinde, sonrasında ve interferon-β tedavisi sonrasında serum B12, folik asit ve homosisitein düzeylerindeki değişiklikler incelenmiştir. Çalışmaya 1 yıl içinde akut atak ile başvuran, klinik kesin MS tanısı konarak takip edilen 31 hasta (8 erkek, 23 kadın) ve 10 kontrol olgusu dahil edildi. 20 hasta akut atak ile başvurdu 7 gün süreyle 1000 mg/gün metilprednizolon uygulandı. 27 hastaya interferon-β tedavisi başlandı. Yüksek doz steroid tedavi sonrası 1. ay düzeyleri ve interferon-β tedavisi alan hastaların 3. ay sonundaki serum vitamin B12, folik asit ve plazma homosistein düzeyleri ölçülerek kontrol grubu ve tedavisi öncesi düzeyleri ile karşılaştırıldı. Kontrol grubuna göre MS hastalarının bazal B12 değerleri daha önceki bulgularla tutarlı olarak daha düşüktü. Hem metilprednizolon, hem de interferon-β tedavisi sonrası B12 ve folik asid değerlerinde yükselme saptandı ancak sadece metilprednizolon tedavisi sonrasındaki artış istatiksel olarak anlamlıydı. Çalışmamızda saptanan metilprednizolon sonrası yükselen B12 ve folik asid düzeyleri ve istatistiksel anlamlılığa ulaşmayan homosistein düzeylerindeki düşme eğilimi farklı tartışmalar yaratmaktadır.

Anahtar Kelimeler

• multipl skleroz,metilprednizolon,interferon-β,vitamin B12,folik asit,homosistein

Kaynakça

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