From the FDA Drug Label
In the treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day for 1 month have been shown to be effective. (Dosage range is the same for prednisone and prednisolone.)
The recommended dose for an MS flare is 200 mg of prednisone for a week, not 625mg. 1
From the Research
A 625mg oral prednisone dose for an MS flare is not the recommended dose, as the most recent and highest quality study suggests that a lesser high-dose oral methylprednisolone regimen may not be inferior to the standard high dose in terms of clinical and radiological response 2. The typical high-dose oral steroid regimen for MS flares is 500-1000mg of methylprednisolone daily for 3-5 days, or oral prednisone at 1000-1250mg daily for 3-5 days (equivalent to 200-250mg prednisone daily) 2. After the initial high-dose treatment, patients often require a tapering schedule over 10-14 days to prevent withdrawal symptoms. Common side effects include insomnia, increased appetite, mood changes, elevated blood sugar, and stomach irritation. Taking the medication with food, monitoring blood glucose, and watching for signs of infection are important during treatment. High-dose steroids work by reducing inflammation in the central nervous system, decreasing the immune response that causes demyelination during MS flares. If oral therapy is preferred over IV, please consult with your neurologist for the appropriate dosing regimen.
Some key points to consider:
- The study by 2 compared clinical and radiological effectiveness, safety, and quality of life of oral methylprednisolone [1250 mg/day (standard high dose)] versus 625 mg/day (lesser high dose), both for 3 days, in MS relapses.
- The primary outcome was achieved, with a mean EDSS score difference of -0.26 (-0.7 to 0.18) at 30 days (P = 0.246) 2.
- The standard high dose yielded a superior EDSS score improvement on day 7 (P = 0.028) 2.
- Safety and quality of life were good at both doses 2.
It's essential to prioritize the most recent and highest quality study, which in this case is 2, to ensure the best possible outcome for patients with MS flares.