Oral Steroids Effective in MS

Published: April 24, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

NEW ORLEANS — Outcomes for multiple sclerosis patients in relapse who were treated with oral methylprednisolone were no different than those of similar patients who received intravenous steroids, researchers reported here.

After 28 weeks, 16 of 22 patients (72.7%) given oral medication achieved at least a one point improvement in the standard Expanded Disability Status Scale compared with 16 of 23 patients (69.6%) who were treated with the drug IV (P=1.0), according to Cristina Ramo-Tello, MD, a staff neurologist at H. Germans Trias I Pujol Hospital in Badalona, Spain.

“We were able to show that 1,250 mg of oral methylprednisolone given daily for 3 days was not inferior to the bioequivalent 1,000 mg of methylprednisolone daily for 3 days administered intravenously,” Ramo-Tello told MedPage Todayat a poster presentation at the American Academy of Neurology meeting.

“We know that corticosteroids improve the rate of recovery from multiple sclerosis relapses,” she said, “but the optimal dose, frequency and duration of treatment, and the route of administration are unknown.”

Generally, she said physicians treat patients with IV methylprednisolone for 3 to 5 days, and then they may taper the steroid dose.

Noting previous trials in which the oral form of the drug was used without compromising outcomes, the researchers enrolled patients at seven hospitals in the Catalonia region of Spain into the phase IV double blind, randomized trial.

“We found no differences in outcomes or in adverse events,” Ramo-Tello said. The side effect profiles for both groups of patients were almost mirror images. Two patients receiving oral methylprednisolone experienced diarrhea; 19 patients on the oral drug experienced insomnia, compared with 14 receiving the intravenous administration.

“This study is confirmation of what we found in our study,” said Marcelo Kremenchutzky, MD, associate professor of neurology at the University of Western Ontario and the London Health Sciences Center in London, Ontario, as he reviewed the poster presentation. He did not participate in the Spanish study.

“We also found that patients do find oral treatment more convenient than intravenous therapy,” Kremenchutzky told MedPage Today. “It’s not inferior. It’s cheaper for the system or the payor depending where they are, and patients do not have any more gastrointestinal side effects with the oral treatment than with intravenous treatment.”

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