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a Medicines Research
Unit, University of Wales, Cardiff, UK, b Department of Medicine (Neurology)
University of Wales College of Medicine, Cardiff, UK
Correspondence to: Ms Helen Tremlett, Medicines Research Unit, University of Wales, Cardiff CF1 3XF, UK. Telephone 0044 1222 874783; fax 0044 1222 874535; email tremletthl{at}cardiff.ac.uk
Received 18 December
1997 and in revised form 9 March 1998;
Accepted 16 April 1998
OBJECTIVES
To survey
the use of corticosteroids in multiple sclerosis as recommended by
United Kingdom consultant neurologists.
METHODSA postal
questionnaire covering the use of corticosteroids for acute multiple
sclerosis relapse and chronic progressive multiple sclerosis with
regard to frequency of use, type of corticosteroid, and dosage regime
was sent to all members of the Association of British Neurologists with
a United Kingdom address.
RESULTSTwo hundred
and twelve United Kingdom consultant neurologists replied to the survey
(74% response rate). Eighty six per cent indicated that they
prescribed corticosteroids in more than one quarter of acute multiple
sclerosis relapses seen. Intravenous methylprednisolone was recommended
at some time by 99% of consultant neurologists, the most popular
regime being 1g daily for 3 days (74%; 154/208). Over one half (53%;
109/206) never recommended a subsequent tapering course of oral
corticosteroids; of those that did, 25% (24/96) recommended a tapering
course lasting more than 1 month. Eighty eight per cent (181/206) of
prescribers of intravenous methylprednisolone were able to offer the
course as a day case on the ward; 7% (15/206) at an outpatient clinic;
and 5% (11/206) at home. Almost three quarters of neurologists
recommended oral corticosteroids for some acute relapses, although the
most popular response was for occasional use only (48%; 101/212).
Forty five per cent (96/211) at least occasionally recommended steroids for patients with chronic multiple sclerosis not experiencing an acute relapse.
CONCLUSIONSAlthough
the vast majority of consultant neurologists would prescribe
intravenous methylprednisolone for acute multiple sclerosis relapse at
some time, the use of corticosteroids for multiple sclerosis was
otherwise variable. There seemed to be little consensus about the use
of oral steroids in acute relapse, the prescribing of a tapering course
of oral steroids after intravenous methylprednisolone, or the utility
of steroids in chronic multiple sclerosis. Variability of prescribing
recommendations probably reflects a lack of clear evidence in the face
of a wide range of clinical situations, variable access, and timing of
access to neurologists in the acute phase of relapse and pressure on
neurologists to treat in an otherwise "hopeless" situation. Large
multicentred trials are needed to consider these issues.
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