LOW-DOSE ORAL METHOTREXATE IN CHRONIC PROGRESSIVE MULTIPLE-SCLEROSIS - ANALYSES OF SERIAL MRIS

We monitored 56 patients with chronic progressive multiple sclerosis ( MS) who participated in a clinical trial of weekly, low-dose oral meth otrexate with annual gadolinium-enhanced MRIs of the brain (Gd+MRI). N one of these patients had clinical exacerbations during the 8 months p receding study entry. We also monitored 35 of these patients with seri al Gd+MRIs every 6 weeks for 6 months. We observed a treatment effect, measured by absolute change in T-2-weighted total lesion area (T2W-TL A), in the cohort that completed 6-week scans. We found change in T2W- TLA in this cohort to be significantly related to sustained change in performance on the nine-hold peg test but not to sustained change on t he Expanded Disability Status Scale. Gadolinium enhancement of lesions on 6-week and annual scans was uncommon. Prestudy exacerbation freque ncy appears to be an important consideration in designing future clini cal trials in patients with secondary and primary progressive MS.