What Is the Role of Steroids in MS?

Glucocorticoids, most commonly methylprednisolone or prednisone, are typically used for symptomatic treatment of MS relapses. They are said to potentially shorten the time to recovery, but not ultimately change the degree of recovery. Glucocorticoids are not considered DMTs. Rather, they produce a number of beneficial anti-edema and anti-inflammatory effects, including temporarily decreasing blood brain barrier permeability and shutting off production of pro-inflammatory cytokines and other inflammatory and potentially damaging substances.

Recent studies suggest that glucocorticoids may have an impact on the MS disease process. In a single-center phase 2 trial, patients with relapsing MS were randomized to either receive regular pulses of intravenous steroids or only be treated at the time of relapse. At 5 years, the pulse steroid-treated patients showed less disability, brain atrophy, and T1 brain lesion load compared with those in the control group, who received steroids only for acute relapses.[49] Another small study evaluated brain lesions detected on monthly MRI scans of 4 patients with relapsing MS. Lesions showed the least permanent tissue damage (as measured by magnetic transfer ratio) when patients were treated with steroids.[50] The greatest tissue damage was noted in untreated lesions, while moderate damage was noted in lesions that occurred in IFN beta-treated patients. However, because complications involved with long-term steroid use may be significant, the role of steroids in management of MS needs further study, in terms of both safety and efficacy.

Summary
Fundamental changes in our understanding of MS are refining treatment approaches. Current emphasis involves early use of DMT and use of logical combination strategies when the response to monotherapy is suboptimal. Future emphasis will involve axon/neuron strategies, novel therapies, and effective repair mechanisms.