Oral, IV Methylprednisolone Show Similar Benefits for Multiple Sclerosis Relapse

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Both oral and intravenous methylprednisolone showed clinical benefit for patients experiencing multiple sclerosis relapse.
Both oral and intravenous methylprednisolone showed clinical benefit for patients experiencing multiple sclerosis relapse.

Both oral and intravenous administration of methylprednisolone confers similar clinical improvements at 28 days in patients with relapse of multiple sclerosis (MS), according to a meta-analysis published in PLoS One.

Researchers compared outcomes data from randomized controlled trials examining the efficacy, safety, and tolerability of oral vs intravenous methylprednisolone in patients experiencing MS relapse. The final set of studies (n=5) that matched the investigators' inclusion criteria included 369 patients.

At 28 days, patients taking either oral or intravenous methylprednisolone experienced similar clinical improvements in MS relapse (risk ratio [RR] 0.96; 95% CI, 0.84-1.10). Among the 180 participants in the oral group and 189 participants in the intravenous group, improvement occurred in 121 and 134, respectively (RR 0.96; 95% CI, 0.84-1.10).

The 3 studies that reported adverse events found no statistically significant differences between the 2 groups with regard to the rates of headache (RR 1.17; 95% CI, 0.98-1.39), stomach pain (RR 1.04; 95% CI, 0.79-1.38), nausea (RR 0.91; 95% CI, 0.63-1.31), diarrhea (RR 1.30; 95% CI, 0.76-2.23), anxiety (RR 0.99; 95% CI, 0.73-1.34), dysgeusia (RR 1.06; 95% CI, 0.98-1.14), and palpitations (RR 1.30; 95% CI, 0.90-1.89). Insomnia, however, occurred more frequently in the oral vs the intravenous group (RR 1.25; 95% CI, 1.06-1.47).

Doses of methylprednisolone in each study were not identical, which may have limited the researchers' ability to determine whether different dosing strategies would have increased or decreased clinical improvement and/or adverse event rates. Additionally, many of the studies included in this meta-analysis were not conducted with reliable methods of randomization or allocation concealment.

Despite the equal efficacy rates of oral and intravenous methylprednisolone for the treatment of MS relapse, the investigators suggest that oral versions, “which are less expensive, less invasive, and more convenient, may be an effective alternative to intravenous steroids for the treatment of MS relapses.”

Reference

Liu S, Liu X, Chen S, Xiao Y, Zhuang W. Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: a meta-analysis of randomized controlled trials. PLoS One. 2017;12(11):e0188644.

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