MS Patients Report Excellent Compliance with Oral Prednisone for Acute Relapses

Abstract

Background:Multiple Sclerosis is characterized by relapses separated by periods of relative quiescence. High dose intravenous corticosteroid pulses for three to five days is the current standard for the treatment of acute relapses, but recent evidence supports the use of equivalent doses of oral therapy as an alternative. The highest single dose preparation of oral prednisone is a 50mg tablet, requiring patients to take 25 tablets a day. Questions regarding compliance with this oral regimen have been raised.Objectives:To determine whether MS patients are complaint with 1250mg of oral prednisone daily for acute relapses.Methods:Between November 2008 and December 2009, all patients diagnosed with an acute relapse in the London (Ontario) MS clinic were prospectively identified. If treatment with oral prednisone was initiated, subjects were given a survey to be mailed anonymously to the clinic.Results:Sixtyeight MS relapses were diagnosed and treated with corticosteroids in 66 patients of which 60 (58 subjects) were treated with 1250mg prednisone. Fifty-three (91.4%) surveys were returned. The reported compliance rate was high at 94.3% (50/53) with only one patient reporting being unable to take all the required pills due to intolerance. Most subjects (43, 86.0%) encountered at least one side effect, most commonly insomnia, mood changes and increased appetite. Two thirds of subjects (69.8%) indicated a preference for oral medication for future relapses.Conclusion:High dose (1250mg) oral prednisone is an acceptable therapy to MS patients for the treatment of acute relapses with a high rate of compliance.

A randomized clinical trial of oral versus intravenous methylprednisolone for relapse of MS

“…12 Considerable variability between specialists in the prescription of this treatment has been observed in clinical practice. 13,14 Patients tend to prefer oral administration over intravenous therapy, [15][16][17][18] because it interferes less with family and social life, is more convenient, and avoids the contact with needles. In keeping with the hypothesis investigated by other authors that oral methylprednisolone (oMP) is not inferior clinically or radiologically to intravenous methylprednisolone (ivMP), and that it is equally well tolerated and safe, [17][18][19] we conducted the present clinical trial for the treatment of MS relapse with the aim of providing evidence that would tilt the scale toward oral administration of steroids to spare patients from more invasive, less convenient, and more costly medical practice.…”

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

“…However, oral medication may be more convenient, minimizing travel to an infusion center, especially for those residing in rural locations. In addition, our previous study showed that oral administration is preferred by persons with MS . The use of oral administration is also more cost-effective.…”

“…Participants randomized to the oral group were provided 75 tablets of 50 mg of prednisone (25 tablets daily) to consume at home. Compliance with this oral regimen has been previously shown to be very high (compliance rate, 98%) . No taper was used after the 3-day treatment because previous research indicates tapering has no effect on short- or long-term outcomes …”

Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment

“…Recovery was equal with or without subsequent oral corticosteroid tapering. [33] (2) Plasma exchange: Patients who experience fulminant attacks that do not respond to glucocorticoids may benefit from 5 to 7 exchanges:40 to 60 mL/kg each exchange given every other day for 14 days. However, the price is considerable, and there is not enough solid proof of its effectiveness.…”