Corticosteroids for MS: Benefits and Side Effects

Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system (CNS). There are several forms of MS, including relapsing-remitting multiple sclerosis (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). Treatment of multiple sclerosis includes many different therapeutic strategies, including corticosteroids.

Corticosteroids are commonly used during acute MS relapses (also called flare-ups or exacerbations). People dealing with MS may wonder how corticosteroids work and what potential side effects they have.

What Are Corticosteroids?

Corticosteroids, also called steroids or glucocorticoids, are a type of synthetic anti-inflammatory drug. Corticosteroids are very similar to cortisol, a hormone produced in the body by the adrenal glands. Corticosteroids are different from hormone-related steroid drugs used to enhance athletic performance.

Corticosteroids work by decreasing inflammation and reducing immune system activity. In autoimmune diseases, such as MS, the body’s immune system malfunctions, attacking the protective covering (myelin) surrounding nerve fibers. This attack creates damaged areas called lesions, resulting in communication problems between the brain and body. These communication problems, in turn, cause symptoms of MS. Corticosteroids work by suppressing the immune system and reducing inflammation around the site of nerve damage. This suppression helps keep nerve damage as low as possible.

Types of Corticosteroids

There are several common types of corticosteroids, including:

• Cortisone
• Prednisone
• Methylprednisolone (MP) such as Solu-Medrol

Corticosteroid medications are available in several forms that vary in how they are administered and how long they stay in the body. They often come in both high-dose and low-dose forms. Doctors administer steroids in a hospital, infusion center, or sometimes at home. Steroids can be taken in different ways:

• Topically (applied to the skin)
• Orally (taken by mouth)
• Intravenously injected (delivered into a vein)
• Intramuscularly injected (delivered into a muscle)

Corticosteroids Benefits for MS

Corticosteroids are used to treat people with acute MS exacerbations. During multiple sclerosis relapses, individuals experience a temporary worsening or return of symptoms. Relapses can last for days or months and are often followed by a period of recovery (remission).

When taken short term, corticosteroids are safe and effective for MS flare-ups. Steroids help people improve more quickly by lessening the severity and duration of acute exacerbation symptoms, including vision changes (optic neuritis), fatigue, balance problems, and numbness. However, steroids do not affect the long-term course or progression of MS.

Corticosteroids are often used to treat moderate to severe MS relapses, and should be started as soon as possible. Ideally, studies show that it is best to begin steroid treatment within a week of MS-relapse symptom onset.

Corticosteroids Used for the Treatment of MS Relapses

Intravenous (IV) methylprednisolone (IV-MP) is the most commonly used steroid treatment for MS relapses. People with MS relapses are usually treated with intravenous methylprednisolone once a day for three to five days. Methylprednisolone is also available in tablet form, which is given daily for five days.

Doctors may prescribe the corticosteroid Decadron (dexamethasone) instead of IV methylprednisolone. Although not yet approved by the Food and Drug Administration (FDA), high-dose oral methylprednisolone has been shown to be as safe and effective as IV-MP. Sometimes, people are eased off high-dose intravenous steroids using oral steroids such as prednisone. Oral prednisone is usually given in a tapering dose for an additional one to two weeks.

Related to corticosteroids, Acthar Gel is approved by the FDA to treat MS relapses. Acthar Gel, which contains a purified form of a chemical called adrenocorticotropin (ACTH), works by stimulating the body to produce natural steroid hormones. These natural hormones work to reduce inflammation and suppress the immune system, similarly to corticosteroids. Acthar is injected under the skin or into muscle. It is given only once a day for two to three weeks. Studies demonstrate that Acthar Gel is as effective as corticosteroids. Acthar Gel is typically used to treat MS in people who are not able to tolerate corticosteroids or are not able to go to an inpatient facility to receive corticosteroids.

Watch MS expert Dr. Aaron Boster talk about the differences between side effects and symptoms.

Corticosteroid Side Effects

Although corticosteroids are an important tool in the management of multiple sclerosis, the treatment has several short-term and long-term adverse effects. Not everyone experiences the negative effects of steroids. When side effects do occur, they are often mild and go away quickly once treatment ends.

Potential short-term corticosteroid side effects include:

• Allergic reaction
• Metallic taste in the mouth
• Indigestion, stomach pain
• Difficulty sleeping
• Mood swings
• Anxiety
• Facial flushing
• Increased appetite
• Headache
• Heart palpitations (faster heart rate)
• Chest pain
• Rash
• Ankle swelling
• High blood pressure

In rare cases, some people experience severe depression when taking steroids. Those experiencing extreme mood changes should seek medical attention as soon as possible.

Long-term steroid use can lead to additional side effects, including:

• Weight gain
• Acne
• Cataracts
• Osteoporosis
• Diabetes
• Deterioration of part of the thigh bone (known as avascular necrosis of the hip)

To prevent severe side effects, many doctors limit long-term and high-dose steroids for MS treatment. A neurologist can explain the benefits and potential side effects of taking steroids. Individuals with MS should discuss treatment options with their health care team to determine the best course of action.

Talk With Others Who Understand

MyMSTeam is the social media network for people with multiple sclerosis and their loved ones. More than 168,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Share your experience with corticosteroids in the comments below, or share your story on MyMSTeam.