Oral Steroids Not Inferior to Intravenous Steroids in Multiple Sclerosis Relapses
• Steven Deitelzweig, MD, SFHM, William Carter, MD, David Kitchell, MD, Alan Hathcock, MD, Jeremiah Newsom, MD, Frank Wharton, MD; Ochsner Health System, New Orleans
Background: When relapses of multiple sclerosis occur, studies have shown that intravenous steroids are the treatment of choice. Prior Cochrane meta-analyses have not found any significant difference between intravenous and oral treatments; however, the studies all have had limitations. This study was designed to provide a statistically significant answer.
Study design: Randomized, double-blinded, noninferiority trial.
Setting: Thirteen multiple sclerosis centers in France.
Synopsis: Patients were selected if they had had a relapse within the previous 15 days; the mean time was seven days. One hundred patients were in the oral steroid group, and 99 were in the intravenous steroid group. Each group received 1 g of methylprednisolone daily for three days. In addition, each group received saline infusions or placebo capsules to keep the study blind.
After 28 days, 81% of the oral group and 80% of the intravenous group had improvements of their symptoms. Side effects from the medications were similar as well.
The study was limited by the fixed dosing (1 g daily) that was not bioequivalent. Also, MRIs, although not always used in relapses, could have added more objective information, as everyone was followed clinically using the Kurtzke Functional System Scale.
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