Glucocorticosteroid therapy for multiple sclerosis: a critical review.
Controversy remains as to the efficacy, route of administration and dose of glucocorticosteroid (GCS) in multiple sclerosis (MS) therapy. With the recent approval of new disease modifying treatments and increasing interest in cost-benefit assessments, it is timely to critically consider their role in MS therapeutics. In this paper we review our current understanding of the cellular and molecular mechanisms of action of GCS as they relate to the postulated pathophysiology of MS. We also critically review the use of glucocorticosteroid therapy to: (1) improve recovery from exacerbations of MS, (2) delay the onset of MS in patients who experience a first episode of monosymptomatic optic neuritis, and (3) delay the time to onset of sustained progression of disability in patients with clinically definite MS.
Andersson
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PB
The UCSF/MT Zion Multiple Sclerosis Center, San Francisco, CA 94115-1642, USA.
Goodkin
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DE
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001324:Autoantigens / Q000276:immunology; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D002986:Clinical Trials as Topic; D005786:Gene Expression Regulation / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007275:Injections, Intravenous; D018448:Models, Immunological; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000276:immunology; D009902:Optic Neuritis / Q000188:drug therapy; D011446:Prospective Studies; D013256:Steroids; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001324:Autoantigens; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D013256:Steroids; D000324:Adrenocorticotropic Hormone