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Medical Author:

Fernando Dangond, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Methylprednisolone (Solu-Medrol) is the corticosteroid most frequently used intravenously to speed up the recovery from multiple sclerosis attacks. It is most helpful if administered shortly (within a few days) after the onset of the attack.

• How corticosteroids work: Corticosteroids affect immunologic actions, such as inflammation (swelling) and immune responses associated with an acute (sudden) attack of multiple sclerosis. Corticosteroids are used for short periods to reduce the duration and severity of symptoms associated with a sudden attack.



• Who should not use these medications:
  
  
  • Individuals allergic to corticosteroids
  
  
  
  • Individuals with active peptic ulcer disease
  
  
  
  • Individuals with systemic fungal infections
    
    
• Who should use caution in using these medications:
  
  
  • People with diabetes, seizures, hypertension, congestive heart failure, osteoporosis, tuberculosis or viral infections, or impaired liver function
  
  
  
  • People taking other medications (These people should consult their doctor because levels of some drugs may be elevated when used along with corticosteroids.)
    
    
• Use: Solu-Medrol is administered intravenously (IV) for 3-5 days to treat a sudden multiple sclerosis attack. Steroids do not have an impact on the degree of clinical recovery, but rather in shortening the timing to recovery.



• Drug or food interactions: Many drug interactions are possible. Contact a doctor or pharmacist before taking a new prescription or over-the-counter medications. Aspirin; nonsteroidal anti-inflammatory drugs, such as Advil or Aleve; or other drugs associated with stomach ulcers may increase the risk of developing stomach ulcers. Corticosteroids may decrease potassium levels; therefore, caution must be used when taking other drugs that decrease potassium levels, such as diuretics [for example, furosemide (Lasix)].



• Side effects: Ideally, corticosteroids are used for short periods in order to control sudden flares in multiple sclerosis symptoms. Short-term use may cause fluid retention, potassium loss, stomach distress, weight gain, and changes in emotion. Long-term use is associated with serious side effects such as osteoporosis (calcium and vitamin D supplementation is advised), adrenal insufficiency, psychosis, immunosuppression, peptic ulcer, hypertension, insomnia, menstrual irregularities, acne, skin atrophy, elevated blood sugar, abnormal appearance of the face (Cushingoid face), increased risk of infection, and cataracts.
  
  
  • Induction of problems with blood sugar levels and worsening of diabetes control: Changes in diet or initiating oral antidiabetic drugs or insulin may be required. For individuals who already have diabetes, dosage changes may be needed for the insulin or the antidiabetic drugs.
  
  
  
  • Weight gain: This is a common problem with high-dose corticosteroids due to fluid retention and endocrine alterations. Salt restriction is advised, and with a doctor's approval, potassium supplementation may be needed. A doctor may prescribe a diuretic (water pill) to increase urination to eliminate some of the excess fluid.

Interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron), and glatiramer acetate (Copaxone), are examples of immune-modifying drugs used for multiple sclerosis.

Generally, these medications tend to decrease the frequency of attacks in patients with mild-to-moderate relapsing remitting MS (RRMS) by 18% to 33%. The rate of new lesions that appear on magnetic resonance imaging (MRI) is also reduced by approximately one-third. With the interferon drugs, the effectiveness is directly related to the dose (higher doses of IFN, if tolerated, are generally more effective). Whether the delay in the onset of new attacks by these drugs ultimately has a long-term impact on the disability associated with multiple sclerosis is controversial. However, clinical trials suggest that patients receiving early treatment have a beneficial impact on relapses and disability that may not be matched by patients in whom the treatment is delayed. Research regarding this continues.

The ability to respond to long-term interferon beta-1a and beta-1b may be limited, in some patients, by the development of persistent, high titer neutralizing antibodies. Patients treated with glatiramer also eventually develop antibodies, but these antibodies do not seem to limit glatiramer's activity.

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