Management of HAM/TSP Systematic Review and Consensus-based Recommendations 2019

Purpose of Review To provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)-a rare disease. Recent Findings All 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, based for the most part on observational studies, with only 1 double-masked placebo-controlled randomized trial. Summary There is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5 mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-alpha as a first-line therapy.

Automated summary

Recent review of clinical studies on disease-modifying therapy for HAM/TSP concluded that high-dose pulsed methyl prednisolone is effective for induction, while low-dose oral prednisolone is recommended for maintenance therapy. However, there is not enough evidence to support the use of antiretroviral therapy or interferon-alpha as a first-line treatment for the disease.