It is common practice to employ a short course of corticosteroids to treat acute relapses of multiple sclerosis. Two approaches, high dose intravenous methylprednisolone (IVMP) and intramuscular ACTH, have been shown when compared to placebo to shorten the duration of relapses,^1 2 although there is no evidence that the final outcome is changed. Of these, IVMP has become the more popular, being a shorter course (typically 3-5 days versus 2 weeks), and indeed ACTH is no longer available for use in the United Kingdom. Relatively small studies have suggested equivalence between oral corticosteroids (using various dose regimes) and IVMP in treating multiple sclerosis relapses,³ although the first has not been tested against placebo. In a placebo controlled trial in acute optic neuritis, oral prednisone was not associated with an increased rate of visual recovery, whereas IVMP followed by an oral tapering off period was.⁴

With this incomplete data from controlled trials, it . . . [Full text of this article]