***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: THE PURPOSE of this report is to present the results of a double-blind drug trial in which an oral corticosteroid , methylprednisolone ( Medrol ) , was compared to oral cyanocobalamin ( vitamin B12 ) in patients with multiple sclerosis . This pair of drugs was chosen for comparison for several reasons . If multiple sclerosis is a peculiar auto-immune disease related to the myelin of the brain , then it might be reasonable to expect that corticosteroids may favorably alter the course of the disease.1A number of reports in the recent literature have dealt with clinical trials of corticosteroids and corticotropin ( ACTH ) in the treatment of patients with multiple sclerosis .  Studies by Alex and er et al on corticotropin,2,3which did not include modern statistical design s such as r and omization of administration of placebo and corticotropin and a double-blind technique , have indicated a favorable response . Miller et al,4utilizing a modern statistical design , also concluded that Background Intravenous methylprednisolone ( IV-MP ) is an established treatment for multiple sclerosis ( MS ) relapses , accompanied by rapid , though transient reduction of gadolinium enhancing ( Gd+ ) lesions on brain MRI . Intermittent IV-MP , alone or with immunomodulators , has been suggested but insufficiently studied as a strategy to prevent relapses . Methods In an open , single-cross-over study , nine patients with relapsing-remitting MS ( RR-MS ) underwent cranial Gd-MRI  once monthly for twelve months . From month six on , they received a single i.v.-infusion of 500 mg methylprednisolone ( and oral tapering for three days ) after the MRI . Primary outcome measure was the mean number of Gd+ lesions during treatment vs. baseline periods ; T2 lesion volume and monthly plasma concentrations of cortisol , ACTH and prolactin were secondary outcome measures . Safety was assessed clinical ly , by routine laboratory and bone mineral density measurements . Soluble immune parameters ( sTNF-RI , sTNF-RII , IL1-ra and sVCAM-1 ) and neuroendocrine tests ( ACTH test , combined dexamethasone/CRH test ) were additionally analyzed . Results Comparing treatment to baseline periods , the number of Gd+ lesions/scan was reduced in eight of the nine patients , by a median of 43.8 % ( p = 0.013 , Wilcoxon ) . In comparison , a pooled data set of 83 untreated RR-MS patients from several studies , selected by the same clinical and MRI criteria , showed a non-significant decrease by a median of 14 % ( p = 0.32 ) . T2 lesion volume decreased by 21 % during treatment ( p = 0.001 ) . Monthly plasma prolactin showed a parallel decline ( p = 0.027 ) , with significant cross-correlation with the number of Gd+ lesions . Other hormones and immune system variables were unchanged , as were ACTH test and dexamethasone-CRH test . Treatment was well tolerated ; routine laboratory and bone mineral density were unchanged . Conclusion Monthly IV-MP reduces inflammatory activity and T2 lesion volume in RR-MS In order to assess the effectiveness of monthly intravenous corticosteroids in reducing childbirth-associated acute exacerbations in multiple sclerosis ( MS ) , we compared pregnant patients followed up in our MS clinic . During the first period ( 1996 - 1998 ) , 22 patients did not receive any treatment after delivery . During the second period ( 1999 - 2001 ) , following the publication of the PRIMS study , 20 patients were treated monthly with 1 g of intravenous corticosteroids during the six months of the postpartum period . In both groups the relapse rate increased during the first trimester postpartum but it was higher in the untreated group ( 2±0.66 [ mean±SD ] ) compared with the treated group ( 0.8±0.41 ) ( P=0.018 ) , suggesting a beneficial effect of monthly intravenous corticosteroids Background : IV methylprednisolone ( IVMP ) has been used to treat relapses in patients with relapsing-remitting ( RR ) MS , but its effect on disease progression is not known . Furthermore , there are no data on the impact of IVMP on T1 black holes or whole-brain atrophy . Objective : To determine the effect of IVMP on MRI measures of the destructive pathology in patients with RR-MS and secondarily to determine the effect of IVMP on disability progression in patients with RR-MS . Methods : The authors conducted a r and omized , controlled , single-blind , phase II clinical trial of IVMP in patients with RR-MS . Eighty-eight patients with RR-MS with baseline Exp and ed Disability Status Scale ( EDSS ) scores of ≤5.5 were r and omly assigned to regular pulses of IVMP ( 1 g/day for 5 days with an oral prednisone taper ) or IVMP at the same dose schedule only for relapses ( IVMP for relapses ) and followed without other disease-modifying drug therapy for 5 years . Pulsed IVMP was given every 4 months for 3 years and then every 6 months for the subsequent 2 years . Patients had quantitative cranial MRI scans at study entry and after 5 years and st and ardized clinical assessment s every 4 to 6 months . Results : Eighty-one of 88 patients completed the trial as planned , and treatment was well tolerated . Baseline demographic , clinical , and MRI measures were well matched in the two study arms . Patients on the pulsed IVMP arm received more MP than patients on the control arm of the study ( p < 0.0001 ) . Mean change in T1 black hole volume  favored pulsed IVMP therapy ( + 1.3 vs + 5.2 mL ; p < 0.0001 ) , as did mean change in brain parenchymal volume ( + 2.6 vs −74.5 mL ; p = 0.003 ) . There was no significant difference between treatment arms in the change in T2 volume or annual relapse rate during the study . However , there was significantly more EDSS score worsening in the control group , receiving IVMP only for relapses . There was a 32.2 % reduction ( p ≤ 0.0001 ) in the probability of sustained EDSS score worsening in the pulsed MP arm compared with the relapse treatment arm . At the end of the study , EDSS was better in the pulsed MP group ( 1.7 vs 3.4 ; p < 0.0001 ) . Prolonged treatment with pulsed IVMP was safe and well tolerated ; only two patients dropped out for toxic side effects over 5 years . Conclusions : In patients with RR-MS , treatment with pulses of IVMP slows development of T1 black holes , prevents or delays whole-brain atrophy , and prevents or delays disability progression . A phase III study of IVMP pulses is warranted BACKGROUND Optic neuritis is often the first clinical manifestation of multiple sclerosis , but little is known about the effect of corticosteroid treatment for optic neuritis on the subsequent risk of multiple sclerosis . METHODS We conducted a multicenter study in which 389 patients with acute optic neuritis ( and without known multiple sclerosis ) were r and omly assigned to receive intravenous methylprednisolone ( 250 mg every six hours ) for 3 days followed by oral prednisone ( 1 mg per kilogram of body weight ) for 11 days , oral prednisone ( 1 mg per kilogram ) alone for 14 days , or placebo for 14 days . Neurologic status was assessed over a period of two to four years . The patients in the first group were hospitalized for three days ; the others were treated as out patients . RESULTS Definite multiple sclerosis developed within the first two years in 7.5 percent of the intravenous-methyl-prednisolone group ( 134 patients ) , 14.7 percent of the oral-prednisone group ( 129 patients ) , and 16.7 percent of the placebo group ( 126 patients ) . The adjusted rate ratio for the development of definite multiple sclerosis within two years in the intravenous-methylprednisolone group was 0.34 ( 95 percent confidence interval , 0.16 to 0.74 ) as compared with the placebo group and 0.38 ( 95 percent confidence interval , 0.17 to 0.83 ) as compared with the oral-prednisone group . The beneficial effect of the intravenous-steroid regimen appeared to lessen after the first two years of follow-up . Signal abnormalities on magnetic resonance imaging ( MRI ) of the brain were a strong indication of risk for the development of definite multiple sclerosis ( adjusted rate ratio in patients with three or more lesions , 5.53 ; 95 percent confidence interval , 2.41 to 12.66 ) . The beneficial effect of treatment was most apparent in patients with abnormal MRI scans at entry . CONCLUSIONS In patients with acute optic neuritis , treatment with a three-day course of high-dose intravenous methylprednisolone ( followed by a short course of prednisone ) reduces the rate of development of multiple sclerosis over a two-year period A r and omised double-blind placebo-controlled trial of intravenous methylprednisolone versus oral methylprednisolone at equivalent high dose was carried out on 35 patients with an acute relapse of multiple sclerosis ( MS ) . After baseline evaluation each was r and omly allocated to oral treatment and intravenous placebo or intravenous treatment and oral placebo , receiving 500 mg of methylprednisolone for five consecutive days and with re assessment at days five and twenty-eight . There was no significant difference in response when disability or functional scores were compared in the two groups . Adverse effects were minor and equally distributed . In this study oral treatment with methylprednisolone was as effective as intravenous treatment in acute relapse of MS 
    Output:
    
AUTHORS ' CONCLUSIONS There is no enough evidence that long-term corticosteroid treatment delays progression of long term disability in patients with MS .