Effects of Adrenocorticotropic hormone therapy as a treatment in patients with multiple sclerosis: A Systematic Review

Effects of Adrenocorticotropic hormone therapy as a treatment in patients with multiple sclerosis: A Systematic Review
Parisa Gholambareshi,^1,* Alireza Saadati,² Hojjat Shadman Zahroodi,³ Afarin Rabbani,⁴
1. Faculty of Nutrition Sciences and Food Industry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
3. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
4. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
Introduction: Background and Objective: The use of Adrenocorticotropic hormone (ACTH) in chronic diseases such as multiple sclerosis is a new treatment that has become widely used today. In most studies, this method has been associated with increasing the quality of life of patients. However, the use of this method is less common among physicians and few MS health practitioners are trained in ACTH. The objective of this systematic review was to evaluate the effects of This treatment method (using ACTH) in the recovery of patients with this problem.
Methods: Methods: Data sources: we used Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, Scopus, Web of science and ISI. All studies with Inclusion criteria and keywords ACTH; adrenocorticotropic hormone; multiple sclerosis; treatment were collected from these sources. Review methods: All identified articles from different sources were transferred to a database using resource management software to remove duplicates. Two reviewers independently examined the titles and abstracts of the articles using the inclusion criteria checklist (Human Studies, All randomized controlled trials (RCTs), quasi-experimental randomized controlled trials (quasi-RCTs), cluster randomized trials, case-control and before and after studies containing drug interventions). In case of disagreement between the two, the judgment regarding the inclusion of the article in the study was applied with the opinion of a third reviewer. The PRISMA (Preferred reporting items for systematic review and metanalyses) flowchart is used to present the selection process, which shows how studies enter and exit the systematic review. Articles were reviewed for quality with the help of CASP (Critical Appraisal Skills Programs) tool. The emphasis will be on the methodology of the articles and the biases (selection, performance, identification, attrition, reports) were evaluated.
Results: Results: The number of studies collected according to the inclusion criteria was 259, which after removing duplicates the number of remaining records after eliminating duplicate studies was 131. Finally sixteen studies assessed for eligibility as the main articles. Number of patients involved in our main studies was 541. Reducing the rate of T-lymphocyte in the peripheral blood and serum IgG in cerebrospinal fluid (CSF) and in the blood (significant decrease) was the result of the immune system suppression by ACTH. ACTH injection significantly reduced peripheral blood CD4 + T cell ratio at 2, 6 and 12 months after treatment but no change was observed in CD3 + T cells. Three weeks of ACTH treatment improved patients' visual function, recorded by flash VEPs. Alopecia, nausea and vomiting, and minor infections were the most common complications. The use of this method can positively affect the course of chronic progressive MS in most patients, but a treatment method does not cause permanent improvement and some kind of maintenance therapy or re-treatment is needed.
Conclusion: Conclusion: As a result, medication regimen with this hormone can be effective in improving patients' performance, slowing the progression of the disease and creating an outpatient period to maintain recovery. However, more empirical studies (larger intervention population) are needed to accurately express the effectiveness of this method.
Keywords: Keywords: ACTH; adrenocorticotropic hormone; multiple sclerosis; treatment