From the Research
The first-line treatment for a multiple sclerosis (MS) flare is high-dose corticosteroids, typically methylprednisolone administered orally at 1000 mg daily for 3-5 days, as this route has been shown to be as effective as intravenous administration in recent studies 1.
Key Considerations
- The treatment goal is to reduce inflammation and suppress immune system activity, thereby resolving the acute inflammation in the central nervous system during an MS flare.
- Corticosteroids can shorten the duration of symptoms and accelerate recovery, though they do not affect the long-term course of the disease.
- Common side effects include insomnia, metallic taste, facial flushing, increased appetite, and elevated blood glucose levels.
- Patients should be monitored for mood changes, infection risk, and stomach irritation.
Treatment Approach
- Treatment should begin promptly after confirming a true relapse, characterized by new or worsening neurological symptoms lasting more than 24 hours in the absence of fever or infection.
- Oral methylprednisolone or high-dose oral prednisone (1250 mg daily for 3-5 days) can be used as alternatives to intravenous corticosteroids, with similar efficacy and safety profiles 2, 1.
- The choice between oral and intravenous routes may depend on individual patient factors, such as the severity of symptoms and the risk of complications.
Evidence Base
- Recent studies have demonstrated the effectiveness and safety of oral corticosteroids for treating MS relapses, with no significant differences in clinical outcomes compared to intravenous administration 2, 1.
- The use of oral corticosteroids may be particularly beneficial during the COVID-19 pandemic, as it reduces the need for hospitalization and minimizes the risk of viral exposure 1.