Gastric tolerance of high-dose pulse oral prednisone in multiple sclerosis

Background: Prednisone and methylprednisolone are well absorbed orally and have lower treatment costs than IV methylprednisolone, but concern that low -dose corticosteroid may cause increased disease activity and that high ora l doses may cause gastric ulceration inhibits use of oral therapy for MS at tacks. Methods: Gastric mucosal injury, detected by measurement of gastric permeability, was examined after five alternate day doses of IV methylpredn isolone (1 g) or oral prednisone (1,250 mg) in 21 patients with MS. A tripl e sugar test solution was consumed at bedtime, and urine was collected over night. Urine-sugar concentrations were determined by high-pressure liquid c hromatography. Gastric permeability was expressed as total mg of sucrose ex creted. Results: Seventeen patients completed the protocol (12 oral, 5 IV). Baseline sucrose excretion was normal in all. Both groups demonstrated an increase in gastric permeability after steroid treatment, but there was no difference between the two groups (95% CI 95 to 91 mg, p = 0.96). After tre atment, three (25%) patients in the oral group, and two (40%) patients the TV group, had modestly abnormal gastric permeability (95% CI 34 to 64%, P = 0.6). Conclusions: Short-term high-dose oral prednisone is not associated with greater gastric damage, as measured with permeability tests, than TV m ethylprednisolone. High-dose oral prednisone should be considered a first-l ine treatment option for MS attacks.