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 methotrexate with annual gadolinium-enhanced MRIs of the brain (Gd+MRI). None of these patients had clinical exacerbations during the 8 months preceding study entry. We also monitored 35 of these patients with serial Gd+MRIs every 6 weeks for 6 months. We observed a treatment effect, measured by absolute change in T 2-weighted total lesion area (T 2 W-TLA), in the cohort that completed 6-week scans. We found change in T 2 W-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 the Expanded Disability Status Scale. Gadolinium enhancement of lesions on 6-week and annual scans was uncommon. Prestudy exacerbation frequency appears to be an important consideration in designing future clinical trials in patients with secondary and primary progressive MS. NEUROLOGY 1996;47: 1153-1157