METHYLPREDNISOLONE FOR ACUTE RELAPSES OF MULTIPLE-SCLEROSIS - CAN ORAL REPLACE INTRAVENOUS ADMINISTRATION

Multiple sclerosis (MS) is a chronic inflammatory demyelinating diseas e of the CNS. Probably the most commonly used drugs in MS are corticos teroids. 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 admin istration is inconvenient. Since corticosteroids are well absorbed fol lowing oral administration this route offers a potentially valuable al ternative. Data from the literature show that intravenous treatment wi th corticosteroids shortens the duration of a relapse; however, this t herapy most probably does not influence the degree of improvement. Thi s pattern is seen with several corticosteroid dosages, but direct comp arisons between different intravenous schemes are not available. There have been only 2 double-blind studies performed which compare the eff ect of oral and intravenous administration of corticosteroids. Unfortu nately, these studies were designed in a distinct way and used differe nt dosages of oral corticosteroids and involved small numbers of patie nts. In the largest study (n = 80), there was a relative lack of effec t in both treatment arms. This should be taken into account while inte rpreting the results. In conclusion, to date there is no convincing ev idence that oral corticosteroids are as effective as intravenous corti costeroids in the treatment of acute relapses of MS. Therefore, under these circumstances intravenous administration remains the preferred r egimen.