Use of Oral Steroids to Treat MS Relapse Is Growing

OTTAWA — The use of oral rather than intravenous (IV) steroids to respond to relapses in patients with relapsing-remitting multiple sclerosis (RRMS) is growing, a study suggested. The data, which were presented in a moderated poster session at the annual meeting of the Canadian Neurological Sciences Federation (CNSF) Congress 2025, indicate a decreasing reliance on steroids over time to manage relapses.

Researchers retrospectively examined data from 2010 to 2022 from the MS database MuSicaL. Investigators identified 2413 eligible patients for their analysis, and 1086 had at least one attack or relapse. Of these 1086 patients, half (543) had used high-dose steroids for 818 attacks. Information on the route of high-dose steroids was known in 348 attacks. IV steroids were administered for 148 attacks (42.5%), and oral steroids for 208 (59.8%) attacks.

Oral and IV steroids are considered to have equal efficacy, study author Jihad Al Kharbooshi, MD, a fourth-year adult neurology resident at London Health Sciences Centre in London, Ontario, told Medscape Medical News. “There have been studies involving patients with RRMS who received IV and oral steroids. Both groups of patients were compared, and they found the same effect” in terms of efficacy, he added.

A review paper published in 2013 cited several investigations that compared IV steroid management with oral steroid management. These investigations concluded that the routes managed relapses in patients with RRMS with comparable efficacy.

“The second objective [of the present study] was to see whether the patient’s type of relapse had anything to do with oral versus IV steroids being used,” said Al Kharbooshi.

The researchers found that patients who experienced a multifocal relapse, which is a more severe type of relapse, were more likely to receive IV steroids than oral steroids (39.3% vs 25.5%). “If the physician perceived that the relapse was very serious, such that it may be a life-endangering situation, they may have chosen IV steroids,” said Al Kharbooshi. Clinicians may believe that IV steroids can better manage more severe relapses, he added.

The researchers also analyzed the route of administration according to prescriber specialty. “The specialty of the prescriber, whether a neurologist or another prescriber, didn’t significantly influence the choice of route of high-dose steroids,” said Al Kharbooshi.

Taking steroids orally offers the benefit of convenience for patients with MS who, if they live in remote areas, may not be able to access IV steroids easily, pointed out Al Kharbooshi.

Maryam Nouri, MD, an associate professor of pediatric neurology at Western University in London, Ontario, who moderated the poster session, noted that the growing decline in the use of steroids to manage MS relapses likely results from the greater efficacy of emerging medical therapies for RRMS.

“There was a downward trend toward using steroids to begin with, which could indicate that patients with MS are not experiencing as many relapses,” said Nouri. “This confirms that the treatment landscape of MS has changed, as there are a lot of patients who are starting with high-affinity therapies right from the get-go. It is probably that the number of relapses is declining to begin with, so patients are not requiring as many steroid therapies.”

One limitation of the analysis is that investigators did not have information about the route of steroid use for a substantial proportion of relapses, said Nouri. The investigators acknowledged this shortcoming in their presentation.

Still, the fact that oral steroid use has grown over time suggests that clinicians are giving more consideration to this route of administration, according to Nouri.

“It is positive news that people are feeling more comfortable about using oral steroids,” she said. But in her clinical experience and that of her colleagues, the IV route is still the route of choice for managing MS flares in the pediatric setting, given that the evidence supporting comparable efficacy of IV and oral routes comes from adult studies.

The study was conducted without outside funding. Al Kharbooshi and Nouri reported having no relevant financial relationships.