Corticosteroids and multiple sclerosis

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. …