This study evaluated the effectiveness of a therapy called ACTH, which promotes the release of endogenous steroids, in treating multiple sclerosis relapse. It represents a landmark in trial rigour and quality, despite a rather unsatisfactory conclusion. By 1965, there was agreement that ACTH did not influence multiple sclerosis in the long term, but small-scale reports conflicted on its short-term effect on relapses. Rose and colleagues suspected that ACTH might have an effect, but of small magnitude, which would require careful trial design to reveal. They planned a placebo-controlled trial and recruited 197 patients at 10 neurology centres. They took special care to ensure randomization and reduce investigator bias. The assessment measures used in the trial were carefully compared for consistency and correlation. The study found a significant effect of the treatment, but presented several reasons why it had little clinical significance. Later studies evaluating steroid treatments reached the same conclusion: Steroids reduce the duration of a relapse of multiple sclerosis, but have no impact on the extent of residual disability nor on the subsequent disease course.
Suggested By Alastair Compston and alasdair coles
This study evaluated the effectiveness of a therapy called ACTH, which promotes the release of endogenous steroids, in treating multiple sclerosis relapse. It represents a landmark in trial rigour and quality, despite a rather unsatisfactory conclusion. By 1965, there was agreement that ACTH did not influence multiple sclerosis in the long term, but small-scale reports conflicted on its short-term effect on relapses. Rose and colleagues suspected that ACTH might have an effect, but of small magnitude, which would require careful trial design to reveal. They planned a placebo-controlled trial and recruited 197 patients at 10 neurology centres. They took special care to ensure randomization and reduce investigator bias. The assessment measures used in the trial were carefully compared for consistency and correlation. The study found a significant effect of the treatment, but presented several reasons why it had little clinical significance. Later studies evaluating steroid treatments reached the same conclusion: Steroids reduce the duration of a relapse of multiple sclerosis, but have no impact on the extent of residual disability nor on the subsequent disease course.