Safety of Steroids for relapses

#MSBlog: How safe and well-tolerated are steroids for acute MS attacks?

Shaygannejad et al. Short-Term Safety of Pulse Steroid Therapy in Multiple Sclerosis Relapses. Clin Neuropharmacol. 2013 Jan;36(1):1-3.

OBJECTIVE: To determine the short-term safety of high-dose intravenous methylprednisolone in acute attacks of MS.

METHOD: In a prospective study, we evaluated the MSers who received high-dose intravenous methylprednisolone for acute attacks. By repeated physical and laboratory examinations and history taking, MSers were assessed for adverse effects that would be related to pulse therapy before, within, and 3 months after the treatment.

RESULTS: Sixty-four MSers with acute attack were enrolled in the study in which 46 (71.9%) were female. Fifty-eight MSers (90.6%) developed minor adverse effects of which the most common were palpitation, flashing, dyspepsia, insomnia, and virulent taste. On the other hand, 12 MSers (18.75%) developed major adverse effects, and the most common was sinus tachycardia. Six MSers (9.3%) were without any adverse effects. There was a significant relationship between the dosage of methylprednisolone (3 or 5 g) and the occurrence of major adverse effects (P = 0.025).

CONCLUSION: This study approved that high-dose intravenous methylprednisolone is a safe treatment in MS attacks and the short-term adverse effects were mostly minor and transient.

"This study did not address the major, thankfully, relatively rare adverse events of psychosis and avascular necrosis of the hip. I have seen too many of these events in my career to accept high-dose pulsed steroids as being safe."