From the FDA Drug Label
Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that corticosteroids affect the ultimate outcome or natural history of the disease The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect. In treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of methylprednisolone for a week followed by 64 mg every other day for 1 month have been shown to be effective
Steroid options for MS flares include methylprednisolone, which can be administered intravenously or orally.
- The recommended dose for treating acute exacerbations of multiple sclerosis is 160 mg of methylprednisolone per day for a week, followed by 64 mg every other day for 1 month 1.
- Methylprednisolone can be used to speed the resolution of MS flares, but it does not affect the ultimate outcome or natural history of the disease 1.
- High doses of corticosteroids are necessary to demonstrate a significant effect in treating MS flares 2.
From the Research
High-dose corticosteroids, specifically intravenous methylprednisolone, are the standard treatment for multiple sclerosis (MS) flares, with a typical regimen of 1000 mg administered intravenously daily for 3-5 days. For patients who cannot receive IV treatment, oral methylprednisolone or prednisone can be used as alternatives, with oral prednisone given at 1250 mg daily for 3-5 days being equivalent to the IV methylprednisolone dose 3. The use of high-dose oral corticosteroids has been shown to be effective and safe, with no significant differences in efficacy compared to intravenous administration 3.
Key Considerations
- The treatment should begin as soon as possible after the onset of a flare to maximize effectiveness, ideally within the first week of symptom onset.
- Patients should be monitored for potential side effects, including mood changes, insomnia, increased blood glucose, fluid retention, and gastric irritation.
- For severe flares not responding to standard steroid treatment, plasma exchange may be considered as a second-line therapy, as it has been shown to be superior to escalated methylprednisolone in refractory MS relapses 4.
- The efficacy of oral prednisolone tapering after intravenous methylprednisolone is non-superior to IVMP plus placebo in terms of disability improvement and return to previous state of health, but may be associated with a higher incidence of side effects such as weight gain and increased appetite 5.
Treatment Options
- Intravenous methylprednisolone: 1000 mg daily for 3-5 days
- Oral methylprednisolone: 1000 mg daily for 3-5 days
- Oral prednisone: 1250 mg daily for 3-5 days
- Dexamethasone: 160 mg IV daily for 3-5 days
- Plasma exchange: may be considered as a second-line therapy for severe flares not responding to standard steroid treatment.