The effect of large dose prednisone therapy on intrathecal IgG production in multiple sclerosis

Summary

Several findings support the hypothesis that intrathecal synthesis of IgG is related to the production of multiple sclerosis lesions. Accordingly, one of the goals of an effective therapy in MS should be the eradication of this IgG synthesis. 50 MS patients in an active phase of the disease were treated with 3960mg of prednisone, over a period of 54 days. The initial dose was as high as 200 mg per day. As a result of this treatment we have found a marked drop of both the absolute and relative plasma IgG levels in as much as 82% and 96% respectively of treated patients. A similar effect, i.e. a significant decrease of the absolute and relative IgG concentrations was found in the CSF. The latter effect is largely due to the decrease of plasma IgG concentration, but inhibition of intrathecal IgG synthesis has contributed as well. In 48% of patients which showed an abnormal starting IgG index, and in 59% of cases with an abnormal starting KL/LL ratio in CSF — a full normalization of indices of the local immunoglobulin production was achieved. Negligible changes, i.e. a slight decrease of the CSF IgG level were found in MS patients which demonstrated a normal CSF IgG spectrum before the treatment. The obtained results thus seem to indicate that the CSF IgG spectrum could be a valuable test for the qualification of MS patients for high dose prednisone therapy, that should be preferentially applied in cases showing a distinct intrathecal synthesis of immunoglobulins.