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High Dose Oral Steroids Commonly Used to Treat Relapses in Canadian MS Clinics

  • SA Morrow (a1), LM Metz (a2) and M Kremenchutzky (a1)

Abstract

Background:

Glucocorticoid treatment improves the speed of functional recovery of acute multiple sclerosis (MS) relapses but has not been shown to provide any long-term functional benefit. There is currently no convincing evidence that the clinical benefit is influenced by the route of administration or the dosage of glucocorticoid, or the particular glucocorticoid prescribed. Recent studies support similarities in the bioequivalence and in the clinical effect of high dose oral corticosteroids for MS relapses.

Objective:

This survey aimed to determine the relapse treatment preferences of clinicians in Canadian MS clinics.

Methods:

Members of the Canadian Network of MS Clinics are linked by an email server. A one page survey was distributed to the group to determine and report use of corticosteroids to manage MS relapses amongst Canadian MS specialists.

Results:

Fifty-one clinicians from 17 MS clinics were surveyed. 32 (63%) surveys were returned representing 16 clinics. Five doses are most commonly prescribed, usually without a taper. Three or four doses and the use of a corticosteroid taper, however, are not uncommon. Gastric cytoprotection and sedatives are often prescribed for use as needed.

Conclusion:

This survey illustrates that when Canadian clinicians with expertise in managing MS treat MS relapses they choose high dose corticosteroids, either oral or IV. The results therefore represent Canadian practice as these clinicians provide direct patient care and influence care by community neurologists. Until evidence clearly identifies a superior practice all options should be available to clinicians and their patients.

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Copyright

Corresponding author

University Hospital, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada

References

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1.Goodin, DS, Frohman, EM, JrGarmany, GP, Halper, J, Liksosky, WH, Lublin, FD, et al.Disease modifying therapies in multiple sclerosis: Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002; 58(2):169–78.
2.Sellebjerg, F, Barnes, D, Filippini, G, Midgard, R, Montalban, X, Rieckmann, P, et al.EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. Eur J Neurol. 2005; 12:929–36.
3.Metz, LM, Harris, CJ, Moore, A.MS patients’ choice of oral rather than IV steroid therapy results in savings to the health care system. Int I MS Care [serial online] 2000; 2(2). Available from http://mscare.com. Accessed online luly 2008.
4.Morrow, SA, Stoian, CA, Dmitrovic, I, Chan, SC, Metz, LM.The bioavailability of IV mefhylprednisolone and oral prednisone in multiple sclerosis. Neurology. 2004; 63:1079–80.
5.Martinelli, V, Pulizzi, A, Annovazzi, P, Rocca, MA, Bucello, S, Esposito, F, et al.A single blind, randomized MRI study comparing high doses oral and intravenous mefhylprednisolone in treating MS relapses. [abstract] ECTRIMS Meeting. Oct 14, 2007.
6.Metz, LM, Sabuda, D, Hilsden, RJ, Enns, R, Meddings, IB.Gastric tolerance of high dose pulse oral prednisone in multiple sclerosis. Neurology. 1999; 53:2093–6.
7.Miller, DM, Weinstock-Guttman, B, Beathoux, F, Lee, IC, Beck, G, Block, V, et al.A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations. Multiple Sclerosis. 2000; 6:267–73.
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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