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Ibuprofen does not suppress active multiple sclerosis lesions on gadolinium-enhanced MR images.

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LETTERS
Ibuprofen Does Not Suppress Active Multiple
Sclerosis Lesions on Gadolinium-Enhanced MR
Images
Frederik Barkhof, MD,
Jan-Hein T. M. van Waesberghe, MD,
Bernard M. J. Uitdehaag, MD,
and Chris H . Polman, M D
M R Centre f i r MS Research, Department of Diagnostic
Radiology and Neurology, Academic Hospital of the Wrije
Universiteit, Amsterdam, The Netherlands
Several immunomodulatory drugs have been approved for
the treatment of patients with multiple sclerosis (MS), including interferon P (IFNP). Both IFNP-la and IFNP-lb
show a beneficial effect on clinical and magnetic resonance
(MR) imaging measures of disease activity [ l , 21. In the
study with IFNP-la as reported by ’Jacobs and colleagues [ l ] ,
the side effects of treatment with IFNP, were treated with
acetaminophen, whereas in the final s h # y report with
IFNP-lb [2], it was stated that “systemic flulike symptoms
can be substantially, and in some cases comdletely, suppressed in the initial weeks of IFNP use by concod$tant use
of non-steroidal anti-inflammatory drug (NSAID), fuch as
ibuprofen.” Although Jacobs and associates [ 11 discuss that
the results of the trial are probably not influenced by-concomitant corticosteroid treatment, the use of acetaminopken
and NSAIDs in general has not been considered as a possible
confounder. In this pilot study, we investigated the possible
effect of a commonly used NSAID, ibuprofen, on disease
activity as measured by MR.
Eight patients with active disease were studied before and
after treatment with ibuprofen (1,600 mg/day) for 7 days.
Contiguous 3-mm gadolinium-enhanced (0.3 mmol/kg) M R
images were obtained immediately before and after treatment
at 1.5 tesla (TR 645/TE 15/2 excitations). The M R images
were evaluated by a radiologist blinded ro the order of scanning. The study was approved by the institutional review
board, and all patients gave informed consent after the nature of the procedures had been fully explained.
The imaging results are summarized in the Table. N o statistically significant difference was found for the number of
enhancing lesions (2= -0.94, p = 0.3452). The lesion
load after ibuprofen therapy was marginally lower (3%) than
lesion load before ibuprofen ( Z = - 1.96, p = 0.049).
The minimal effect of ibuprofen on enhancing lesions in
vivo is in keeping with an in vitro study showing that macrophages of MS patients are not very sensitive to NSAID
treatment even though they produce elevated levels of prostaglandin E [3]. We conclude that ibuprofen does not influ-
Tab1e. M R Imaging Findings Before and .43er I Week
Treatment with Ibuprofen
Number of
Lesions
of
L.esion Load (cm3)
--
Mean
Median
Range
Before
After
Before
After
18
8
17
9.6
8.5
1-96
0-90
2.4
0.3-4.9
2.2
0.0-4.2
8
ence the number or volume of active lesions on M R imaging
in MS. It is therefore unlikely that the use of NSAID confounded the pronounced effect of IFNP on gadoliniumenhancing M R lesions in recent clinical trials [ l , 21.
References
1. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-la for disease progression in relapsing multiple
sclerosis: the Multiple Sclerosis Collaborative Research Group
(MSCRG). Ann Neurol 1996;39:285-294
2. Interferon beta-lb in the treatment of multiple sclerosis: final
outcome of the randomized controlled trial. The IFNB Multiple
Sclerosis Study Group and the University of British Columbia
MS/MRI Analysis Group. Neurology 1995;45:1277-1 285
3. Merrill JE, Strom SR, Ellison GW, Myers LW. In vitro study of
mediators of inflammation in multiple sclerosis. J Clin Immunol
1989;9:84-96
Application of the Poser Criteria in Primary
Progressive Multiple Sclerosis
G. V. McDonnell, MRCP,* and S. A. Hawkins, FRCPt
The Poser criteria [I] are widely accepted and applied for the
diagnosis of multiple scberosis (MS). The diagnosis of clinically definite MS (CDMS) by these criteria requires the occurrence of at least two attacks. Patients with primary progressive disease (PPMS), representing around 10% of all
cases, have by definition a progressive course from bnset
without relapse or remission. Designation of such patients as
having CDMS therefore appears incongruous. This difficulty
with the diagnostic criteria in PPMS has recently been discussed [2]. Given the mounting evidence for significant heterogeneity in MS [3, 41 and the advent of treatment trials in
PPMS, appropriate ascertainment and classification of patients are increasingly important. W e have therefore sought
to assess the relevance of the Poser criteria in PPMS by applying them to a significant population of such patients.
In Northern Ireland, 11 1 patients were identified as having PPMS after investigation and interview and examination
by two neurologists. Only those with a progressive course
from onset without relapses were so categorized, although
periods of apparent stability where no progression occurred
were also allowed.
Where possible, each patient was assigned to one of the
Poser categories, namely, CDMS, laboratory-supported definite MS (LSDMS), clinically probable MS (CPMS), or
laboratory-supported probable MS (LSPMS). Those patients
not satisfying the criteria for any category were designated as
having “suspected MS.” Disease onset was defined as the first
and only “attack.” For comparative purposes, a similar exercise was carried out in a recent prevalence study of MS in
Northern Ireland that used the Poser criteria in patient classification [5].
982 Copyright 0 1997 by the American Neurological Association
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ibuprofen, gadolinium, suppressor, lesions, image, activ, enhance, sclerosis, multiple
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