Oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis.
BACKGROUND
A short course of intravenous methylprednisolone (IVMP) followed by oral prednisone taper (OPT) is often used for the treatment of relapses in multiple sclerosis (MS). We examined the effect of IVMP plus OPT compared with IVMP only on neurologic disability 1 year after treatment of a relapse in patients with relapsing-remitting multiple sclerosis.


METHODS
Two hundred eighty-five consecutive relapses were analyzed in a retrospective fashion. One hundred fifty-two patients with a total of 171 relapses received IVMP plus an OPT at the time of relapse whilst 112 patients who experienced 114 relapses received IVMP without OPT.


RESULTS
There was no difference between the two groups in the baseline characteristics as well as the mean or categorical EDSS at baseline, at the time of relapse confirmation, and at months 3, 6 and 12 after relapse confirmation.


CONCLUSIONS
Our observations suggest that OPT following treatment with IVMP for an MS relapse does not lead to improved neurologic outcome after 12 months compared with treatment with IVMP only. Moreover, our findings raise concerns regarding the common practice of using OPT following IVMP. Further studies are indicated to validate our findings and minimize exposure to systemic corticosteroids, well known for systemic toxicity.
Perumal
J S
JS
Department of Neurology, Multiple Sclerosis Clinical Research Center, Wayne State University School of Medicine, Detroit & The Detroit Medical Center, Detroit, MI 48201, USA.
Caon
C
C
Hreha
S
S
Zabad
R
R
Tselis
A
A
Lisak
R
R
Khan
O
O
D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage*; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D011241:Prednisone; D008775:Methylprednisolone