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STUDY: Oral and intravenous steroids for MS relapse: a systematic review and analysis

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  • STUDY: Oral and intravenous steroids for MS relapse: a systematic review and analysis

    Oral steroids are easy, can be done at home, and there are no needles. But you may have more insomnia. I've done both and prefer oral steroids. Other experiences from members? - D

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    J Neurol. 2017 May 10. doi: 10.1007/s00415-017-8505-0. [Epub ahead of print]

    Oral and intravenous steroids for multiple sclerosis relapse: a systematic review and meta-analysis.

    Lattanzi S1, Cagnetti C2, Danni M2, Provinciali L2, Silvestrini M2.

    Abstract
    Glucocorticoids are the standard of care for multiple sclerosis (MS) relapses, but the most desirable route of administration is still matter of debate. The aim of the study was to compare the efficacy and safety of oral versus intravenous steroids for treatment of acute relapses in patients with MS.

    Randomized or quasi-randomized, parallel group trials with direct comparison between oral and intravenous steroid treatment in MS patients with acute relapse were identified through a systematic literature search. Six trials were included involving 419 participants, 210 for oral, and 209 for intravenous groups, respectively.

    The weighted mean differences (WMDs) in the Kurtzke's Expanded Disability Status Scale (EDSS) score reduction between the oral and intravenous groups were 0.32 [(-0.09 to 0.73); p*=*0.129] and 0.11 [(-0.12 to 0.33); p*=*0.355] at 1 and 4 weeks after treatment, respectively. The risk ratios (RRs) for improvement by at least one EDSS point were 0.79 [(0.37-1.68); p*=*0.539] at week 1 and 0.92 (0.76-1.12); p*=*0.400] at week 4.

    There were no differences in the relapse rate and relapse freedom at 6 months between groups. The WMDs in the mean percentage reduction of Gadolinium-enhancing lesions between oral and intravenous arms were 0.14 (-0.02, 0.29); p*=*0.083] and 0.04 (-0.19, 0.28); p*=*0.705] at 1 and 4 weeks from treatment. Among the adverse events, insomnia was significantly associated with the oral route of steroid administration [RR 1.25 (1.07-1.46); p*=*0.005]. In adult patients with acute MS relapse, there were no clear-cut differences in the efficacy and overall tolerability between oral and intravenous steroids.
    Dave Bexfield
    ActiveMSers

  • #2
    Nice to see a study

    Early in my M.S. path, I had a 5 day course of IV high dose steroids about every 6 months or so.

    The steroids did help speed the remission after a relapse, but the side effects after 150+ IV infusions became worse than the relapse itself.

    After several years, I decided to skip the steroids and just ride out relapses in bed. Yes, it takes a bit longer, but without the side effects!
    Retired engineer, now hobby farmer with goats, chickens, an old dog,and a lazy barn cat!
    Watch my goats at GoatsLive.com
    Active in amateur radio
    Linux geek, blogging at lnxgoat.com
    M.S. since 2000

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