Methylprednisolone, a drug used to treat inflammation but not rare kidney disease
Methylprednisolone is a prescription medicine for the treatment of inflammatory diseases such as asthma, arthritis, gout, tendinitis, rejection of transplants, allergic reactions, eczema and psoriasis.
It's in the news because doctors have been testing the drug to find out if it helps treat a rare kidney disease called IgA nephropathy, also known as Berger's disease.
A study published this week reported that an international study with oral methylprednisolone, involving 262 patients (including Australians), was prematurely discontinued for safety reasons. Although the drug was almost threefold lower in risk of kidney failure, there was an almost five-fold higher risk of serious infection. The researchers reported that two patients had died from these study-related infections.
Other clinical studies have also reported higher rates of adverse effects, such as serious infections, with oral methylprednisolone in the treatment of IgA nephropathy.
However, side effects are rare in people who have been prescribed the drug for other reasons. And methylprednisolone should not be confused with similar-sounding medicines from the same family of medicines as prednisolone or prednisone.
Use and formulations
Methylprednisolone is a type of corticosteroid, the same family of medicines that contains hydrocortisone, dexamethasone, prednisone, prednisolone, and triamcinolone.
Corticosteroids are not the same as anabolic steroids, which some athletes and bodybuilders use illegally to build muscle and improve performance.
Corticosteroids suppress inflammation and the immune system by regulating gene expression.
In Australia, methylprednisolone is indicated for acute severe asthma, arthritis (including rheumatoid and osteoarthritis), gout (an arthritis-like disorder due to build-up of uric acid in the blood), tendinitis, acute transplant rejection and some autoimmune diseases such as allergies, eczema and psoriasis.
Methylprednisolone is also on the World Health Organization's list of essential medicines, which are:
... satisfy the priority health needs of the population. They will be selected with due regard to their relevance to public health, effectiveness and safety and comparative cost-effectiveness.
The most recent list, published in March 2017, contains methylprednisolone for the treatment of acute lymphoblastic leukemia. The list also includes the related drug prednisolone for the treatment of various types of leukemia and lymphoma.
While methylpredisolone is available in tablet form in other countries, it is only available in Australia by prescription as an injection or as a skin cream or ointment. As a patent-free drug, it is available from a variety of companies of various brands.
Safety and side effects
The Australian Medicines Handbook (subscription required) states that side effects should be rare (at a rate of less than 0.1%), the most common of which is liver toxicity. It is safe for women to use it immediately after breastfeeding, but they should avoid it within four hours of breastfeeding. This is because very small amounts of the drug can be transferred to the milk.
Other side effects will depend on the dose and the formulation used. When used on the skin, the following side effects may occur: skin thinning, appearance of fine blood vessels, acne, infection of hair follicles, excessive or unwanted hair growth, redness in the mouth, skin discoloration and allergic skin reactions.
In a nutshell
Methylprednisolone is an effective and safe medicine for the treatment of inflammatory and autoimmune diseases. Recent studies on its use in IgA nephropathies have revealed an unacceptably high risk of serious infections.
Nevertheless, you should not take any risks if you take the medicine as prescribed by your doctor. However, if you have any concerns, contact your local pharmacist.
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