Data from: High-dose methylprednisolone for acute traumatic spinal cord injury: A meta-analysis

Objective Due to the continuing debates on the utility of high-dose methylprednisolone (MP) early after acute spinal cord injury (ASCI), we aim to evaluate the therapeutic and adverse effects of high-dose MP according to NASCIS-2 dosing protocol in comparison to no steroids on patients with ASCI, by performing a meta-analysis on the basis of the current available clinical trials. Methods We searched PubMed and Cochrane Library (to May 22 2018) for studies comparing neurological recoveries, adverse events and in-hospital costs between ASCI patients who underwent high-dose MP treatment or not. Data were synthesized with corresponding statistical models according to the degree of heterogeneity. Results We enrolled 16 studies (1863 participants) including 3 RCTs and 13 observational studies. Pooled results indicated that MP was not associated with an increase in motor score improvement (RCTs: p = 0.84; Observational studies: p = 0.44) and incidence of recovery by at least one grade on the ASIA Impairment Scale (AIS) or Frankel (p=0.53). Meanwhile, MP did not lead to better sensory recovery (p=0.07). However, MP was associated with a significant higher incidence of gastrointestinal hemorrhage (p=0.04) and respiratory tract infection (p=0.01). The difference in the overall in-hospital costs between MP and control groups was not statistically significant (p=0.78). Conclusions Based on the current evidence, high-dose MP treatment, in comparison to controls, does not contribute to better neurological recoveries but may increase the risk of adverse events in patients with ASCI. Therefore, we recommend against routine use of high-dose MP early after ASCI.