Oral steroids may be cheaper, more convenient and less invasive alternatives than intravenous steroids in treating relapses in multiple sclerosis (MS) patients, suggests an analysis of five randomized trials.
Glucocorticoids are recommended as the first line of treatment for MS relapses. Yet recent studies have shown no significant difference between oral methylprednisolone (a steroid) and intravenous methylprednisolone in terms of efficacy and safety.
In the study, “Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials,” which appeared in the journal Plos One, Chinese researchers aimed to assess the clinical efficacy, safety and tolerability of oral versus intravenous methylprednisolone to treat MS relapses.
The team used searches to identify studies and trials that involved methylprednisolone treatment for MS. After extensive filtering of the literature, it narrowed the search down to five randomized, controlled trials. Within these trials, 198 patients had received oral methylprednisolone, while 200 patients had received intravenous methylprednisolone. Patients in these studies had similar mean ages and the duration of follow-up was between four and 24 weeks.
None of the studies reported significant differences between the oral and intravenous groups in terms of improvement of clinical outcomes at 28 days after relapse.
Furthermore, no significant differences were observed between the two groups with respect to adverse effects including rash, anxiety, dysgeusia (distortion of the sense of taste), stomach pain, headache, nausea, diarrhea and palpitations.
However, patients in the oral group were more prone to insomnia than those in the intravenous group, which is why the team recommends taking oral methylprednisolone in the morning.
This study has some limitations. The doses of methylprednisolone used in the analyzed studies were not identical and some studies did not use reliable randomization or blinding methods. Furthermore, the studies only reported a single primary outcome regarding efficacy.
Therefore, the team urges more large-scale randomized trials to be conducted to compare both methylprednisolone treatments in MS.
“Despite several limitations, our meta-analysis revealed that there are no significant differences in clinical efficacy and adverse events between oral and intravenous methylprednisolone for the treatment of relapses in multiple sclerosis,” the team concluded. “Based on the evidence, oral steroids, which are less expensive, less invasive and more convenient, may be an effective alternative to intravenous steroids for the treatment of MS relapses.”
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