Corticosteroids for the long-term treatment in multiple sclerosis

Area of Science:

• Neurology
• Immunology
• Clinical Trials

Background:

• Short-term, high-dose corticosteroids alleviate MS exacerbation symptoms and temporary disability.
• The long-term impact of corticosteroids on cumulative MS disability remains uncertain.

Purpose of the Study:

• To evaluate the efficacy and safety of prolonged corticosteroid administration in multiple sclerosis (MS) patients.
• To determine if long-term corticosteroid treatment can prevent the accumulation of disability in MS.

Main Methods:

• Systematic review of controlled, randomized trials (RCTs) of long-term corticosteroid treatment (over 6 months) in MS.
• Searched CENTRAL, MEDLINE, and EMBASE databases, supplemented by reference lists and author/pharmaceutical company contact.
• Included trials regardless of blinding or MS disease course; assessed trial quality and extracted data independently.

Main Results:

• Three high-risk-of-bias trials with 183 participants were included.
• Overall, corticosteroids did not significantly reduce the risk of worsening at follow-up (OR 0.51, 95% CI 0.26 to 1.02) with substantial heterogeneity (I²: 78.4%).
• Pulsed IV methylprednisolone showed a significant reduction in disability progression risk in relapsing-remitting MS (RRMS) at 5 years (OR 0.26, 95% CI 0.10 to 0.66), unlike continuous oral prednisolone.

Conclusions:

• Insufficient evidence exists to support long-term corticosteroid treatment for delaying disability progression in MS.
• A high-quality, adequately powered RCT is necessary to validate the potential benefits of pulsed IV methylprednisolone in RRMS patients.
• Adverse events, including glomerulonephritis and severe osteoporosis, were reported in one study involving IV methylprednisolone.