From the FDA Drug Label
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
The initial treatment for a multiple sclerosis (MS) exacerbation is methylprednisolone administered at a dose of 160 mg daily for 1 week, followed by 64 mg every other day for 1 month 1.
- Key points:
- High doses of corticosteroids are necessary to demonstrate a significant effect in treating MS exacerbations.
- The treatment should be used with caution due to potential side effects, such as psychic derangements, osteoporosis, and increased risk of infections.
- Patients should be monitored closely for signs of infection, and medical advice should be sought immediately if fever or other signs of infection occur.
From the Research
The initial treatment for a multiple sclerosis exacerbation is high-dose corticosteroids, typically intravenous methylprednisolone at a dose of 1000 mg daily for 3-5 days. This recommendation is based on the most recent and highest quality study available, which suggests that high-dose corticosteroids are effective in reducing the severity of MS exacerbations and speeding up recovery 2.
Key Considerations
- The treatment should be initiated promptly when a patient experiences new or worsening neurological symptoms lasting more than 24 hours.
- For patients who cannot receive IV treatment, oral prednisone at equivalent high doses (1250 mg daily for 3-5 days) can be used as an alternative.
- In cases where steroids are contraindicated or ineffective, plasma exchange (plasmapheresis) may be considered, typically administered every other day for 5-7 treatments.
- Corticosteroids work by reducing inflammation and suppressing immune activity in the central nervous system, which helps resolve the acute inflammation causing the exacerbation.
- While steroids speed recovery from exacerbations, they do not affect long-term disease progression, so patients should continue their disease-modifying therapies during and after treatment for the acute exacerbation.
Supporting Evidence
- A study published in 2017 found that intravenous high-dose methylprednisolone (IVMP) is effective in treating MS relapses, with 29.2% of patients achieving full remission and 38.7% achieving partial remission 2.
- Another study published in 2016 found that plasmapheresis and immunoadsorption are effective treatment options for steroid-refractory MS relapses, with significant improvements in visual evoked potentials and visual acuity 3.
- The use of corticosteroids in MS treatment has been extensively studied, with earlier studies such as those published in 2000 and 2009 providing evidence for their efficacy in reducing the severity of MS exacerbations and speeding up recovery 4, 5.
Clinical Implications
- The treatment of MS exacerbations should be individualized, taking into account the patient's medical history, current symptoms, and response to previous treatments.
- Patients should be closely monitored during and after treatment for the acute exacerbation, with regular follow-up visits to assess their response to treatment and adjust their disease-modifying therapies as needed.
- The use of corticosteroids and other treatments for MS exacerbations should be guided by the most recent and highest quality evidence available, with a focus on improving patient outcomes and reducing morbidity and mortality.