Methylprednisolone for acute relapses of multiple sclerosis: Can oral replace intravenous administration?

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS. Probably the most commonly used drugs in MS are corticosteroids. As a rule, corticosteroids are given intravenously in a high dose (500 to 1000mg methylprednisolone) for only a few (3 to 5) days. The adverse effects of this regimen are limited but the route of administration is inconvenient. Since corticosteroids are well absorbed following oral administration this route offers a potentially valuable alternative. Data from the literature show that intravenous treatment with corticosteroids shortens the duration of a relapse; however, this therapy most probably does not influence the degree of improvement. This pattern is seen with several corticosteroid dosages, but direct comparisons between different intravenous schemes are not available. There have been only 2 double-blind studies performed which compare the effect of oral and intravenous administration of corticosteroids. Unfortunately, these studies were designed in a distinct way and used different dosages of oral corticosteroids and involved small numbers of patients. In the largest study (n = 80), there was a relative lack of effect in both treatment arms. This should be taken into account while interpreting the results. In conclusion, to date there is no convincing evidence that oral corticosteroids are as effective as intravenous corticosteroids in the treatment of acute relapses of MS. Therefore, under these circumstances intravenous administration remains the preferred regimen.