Oral vs. Intravenous High-Dose Glucocorticoids for MS Relapses: Your Choice

Clinicians vary in terms of indications for and regimens of glucocorticoids prescribed for multiple sclerosis (MS) inflammatory activity. One lingering question has been whether oral (PO) is noninferior to intravenous (IV) when given in equivalent doses, although small studies have suggested that it is (NEJM JW Neurol Aug 2014 and Mult Scler 2014; 20:717).

This 13-center, double-blind, manufacturer-sponsored, noninferiority trial compared 1000 mg of methylprednisolone PO versus IV daily for 3 days in the setting of a relapse within the previous 15 days. The 199 patients received both IV and PO intervention, one of which was active (assigned at random). The primary endpoint was improvement by at least 1 point on the most affected Functional S…