ALSUntangled #65: glucocorticoid corticosteroids

Jill Ann Goslinga; Mark Terrelonge Jr; Richard Bedlack; Paul Barkhaus; Benjamin Barnes; Tulio Bertorini; Mark Bromberg; Gregory Carter; Amy Chen; Jesse Crayle; Mazen Dimachkie; Leanne Jiang; Gleb Levitsky; Isaac Lund; Sarah Martin; Christopher Mcdermott; Gary Pattee; Kaitlyn Pierce; Dylan Ratner; Lenka Slachtova; Yuyao Sun; Paul Wicks

doi:10.1080/21678421.2022.2099746

ALSUntangled #65: glucocorticoid corticosteroids

Amyotroph Lateral Scler Frontotemporal Degener. 2023 May;24(3-4):351-357. doi: 10.1080/21678421.2022.2099746. Epub 2022 Aug 23.

Authors

Jill Ann Goslinga¹, Mark Terrelonge Jr¹, Richard Bedlack², Paul Barkhaus³, Benjamin Barnes⁴, Tulio Bertorini⁵, Mark Bromberg⁶, Gregory Carter⁷, Amy Chen⁸, Jesse Crayle⁹, Mazen Dimachkie¹⁰, Leanne Jiang¹¹, Gleb Levitsky¹², Isaac Lund¹³, Sarah Martin¹⁴, Christopher Mcdermott¹⁵, Gary Pattee¹⁶, Kaitlyn Pierce¹⁷, Dylan Ratner¹⁸, Lenka Slachtova¹⁹, Yuyao Sun², Paul Wicks²⁰

Affiliations

¹ Neurology Department, University of California San Francisco, San Francisco, CA, USA.
² Neurology Department, Duke University, Durham, NC, USA.
³ Neurology Department, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴ Neurology Department, Augusta University Medical College of Georgia, Augusta, GA, USA.
⁵ Neurology Department, University of Tennessee Health Science Center, Memphis, TN, USA.
⁶ Neurology Department, University of Utah Health, Salt Lake City, UT, USA.
⁷ Physical Medicine and Rehabilitation, Saint Luke's Rehabilitation Institute, Spokane, WA, USA.
⁸ Neurology Department, Medical University of South Carolina, Charleston, SC, USA.
⁹ Neurology Department, Washington University, St. Louis, MO, USA.
¹⁰ Neurology Department, University of Kansas Health System, Kansas City, KS, USA.
¹¹ Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Nedlands, WA, AUS.
¹² Real Health Clinic, Moscow, Russian Federation.
¹³ Green Hope High School, Cary, NC, USA.
¹⁴ Physical Therapy Department, Duke University, Durham, NC, USA.
¹⁵ Institute for Translational Neuroscience, The University of Sheffield, Sheffield, SY, UK.
¹⁶ Neurology Department, University of Nebraska Medical Center, Lincoln, NE, USA.
¹⁷ Undergraduate, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Longmeadow High School, Longmeadow, MA, USA.
¹⁹ Biology and Medical Genetics, Univerzita Karlova Biologicka Sekce, and.
²⁰ Independent Contractor.

PMID: 35997522
DOI: 10.1080/21678421.2022.2099746

Abstract

ALSUntangled reviews alternative and off-label treatments for people with amyotrophic lateral sclerosis (PALS). Here we review glucocorticoids. Neuroinflammation plays a prominent role in amyotrophic lateral sclerosis (ALS) pathogenesis, so some hypothesize that glucocorticoids might be an effective ALS therapy through their immunosuppressive effects. In this paper, we review the available evidence for glucocorticoids in ALS, including one pre-clinical study with a genetic mouse model of ALS, nine case reports (ranging from 1 to 26 patients each), and four clinical trials. We also review the possible side effects (including steroid myopathy) and the costs of therapy. We graded the level of evidence as follows: Mechanism, D; Pre-Clinical, F; Cases, B; Trials, F; Risks, C. Our review of the current evidence concludes that glucocorticoids do not offer clinical benefit in ALS and confer serious risks. Thus, ALSUntangled does not recommend glucocorticoids as a treatment for ALS.

Keywords: Amyotrophic lateral sclerosis (ALS); SOD1; alternative therapy; excitotoxicity; glucocorticoids; neuroinflammation; neuropathology; steroids.

Publication types

Review

MeSH terms

Amyotrophic Lateral Sclerosis* / genetics
Animals
Disease Models, Animal
Glucocorticoids / therapeutic use
Humans
Mice

Substances

Glucocorticoids