Would it be recommended treating multiple sclerosis relapses with high dose oral instead intravenous steroids during the COVID-19 pandemic? Yes

Abstract

The emergence of novel Coronavirus 2019 and the subsequent pandemic are presenting a challenge to neurologists managing patients with multiple sclerosis (MS). The clinical management has dramatically altered and it was necessary to change and/or adapt it to the new situation. Regarding relapses management, the use of intravenous corticosteroids and hospitalization during MS relapses increase the risk of viral exposure. Objective: To review the efficacy and safety of high dose oral corticosteroids in acute relapses treatment compared to intravenous corticosteroids. Methods: Descriptive review of the utility of high dose oral corticosteroids for MS relapses treatment was performed. We searched the literature available on PubMed and Scientific Electronic Library Online (Scielo). We focused on different trials comparing the use of high dose intravenous vs oral corticosteroids. Results: Five studies were selected. One hundred and eighty two patients receiving treatment with high dose oral corticosteroids were included. The most frequent schedule was oral methylprednisolone 1000 mg (over three days). There were no significant differences between both routes of corticosteroids administration. Conclusion: Neurologists should be aware of the current evidence on the similar efficacy of both oral and intravenous corticosteroids for MS relapses. Using oral steroids during the pandemic would be a safe option for patients.

The course of COVID-19 infection in patients with multiple sclerosis–The experience of one center based on the population of Upper Silesia

“…However, systemic infections are associated with an increased risk of MS relapse. 12 COVID-19 infection was not related to the worsening of MS in most patients. Deterioration of the clinical condition in MS patients may be observed during infection or fever.…”

Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina

“…In the current epidemiological scenario, neurologists may consider the new evidence on the similar efficacy of both oral and IV steroids for attacks. 44 Using oral steroids during the pandemic would be an useful and safe option for these patients.…”

Oral administration of methylprednisolone powder for intravenous injection dissolved in water to treat MS and NMOSD relapses during COVID-19 pandemic in a real-world setting

“…The effectiveness and the safety of high-dose corticosteroids orally administered to treat MS relapses has been well documented in many studies ( Alam et al, 1993 ; Le Page et al, 2015 ; Martinelli et al, 2009 ; Morrow et al, 2018 ; Ramo-Tello et al, 2014 ). In recent reviews and meta-analyses, authors identified clinical trials providing evidence that high doses of oMP have similar efficacy as ivMP in reducing EDSS score and gadolinium enhancing lesions in the MRI scan of MS patients ( Lattanzi et al, 2017 ; Liu et al, 2017 ; Martinelli et al, 2009 ; Segamarchi et al, 2020 ). In our study, we included MS patients and also one NMOSD patient with a severe relapse.…”

“…They may be preferable to ivCS for some patients with an MS relapse (Burton et al, 2012) and could represent a remarkable option in order to spare our patients the risk of SARS-CoV-2 transmission (Brownlee et al, 2020;Segamarchi et al, 2020). Unfortunately, oral methylprednisolone (oMP) is not available in Argentina like in other countries.…”