Correct Answer:

Corticosteroids shorten the severity and duration of symptoms from an acute exacerbation, but they have no proven effect on overall disease progression

Educational Objective:

Recapitulate drugs used to treat symptoms of MS.

Key Point:

Short courses of corticosteroids are effective in relieving symptoms of MS but do not influence the natural history of the disease.

Explanation:

Corticosteroids (eg, intravenous methylprednisolone [1 g/day for 3-5 days]) shorten the duration and severity of symptoms from an acute exacerbation of MS, but they have no proven effect on long-term disability. Equivalent dosages of oral corticosteroids are probably equally efficacious and safe.

The U.S. Food and Drug Administration has approved several disease-modifying agents for the treatment of MS, including IFN-β1b, IFN-β1a, glatiramer acetate, natalizumab, and mitoxantrone. IFN-β1b, IFN-β1a, glatiramer acetate, and natalizumab are approved for use in patients with relapsing-remitting MS, and mitoxantrone is indicated for worsening forms of MS as well as for patients with secondary progressive MS.

Intravenous immunoglobulin and plasma exchange have been reported to occasionally benefit patients’ refractory to steroids, but randomized placebo-controlled trials have failed to show any consistent benefits.

References:

Calabresi PA. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman- Cecil Medicine 2016; 411: 2471-2480

Ferri FF. Multiple sclerosis. In: Ferri FF. Ferri’s Clinical Advisor. 2015:785-787