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Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system. 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 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.
Corticosteroids, also called steroids or glucocorticoids, are synthetic anti-inflammatory drugs. Corticosteroids are very similar to cortisol, a hormone produced in the body by the adrenal glands. These medications are not the same as hormone-related steroid drugs used to enhance athletic performance.
Corticosteroids reduce inflammation and immune system activity. In autoimmune diseases, such as MS, the body’s immune system malfunctions, attacking the protective covering (myelin) surrounding nerve fibers. This assault leads to damaged areas called lesions, which disrupt communication between the brain and body. These signaling problems, in turn, cause symptoms of MS.
Corticosteroids work by holding back the immune system and easing inflammation. This suppression helps keep nerve damage as low as possible.
There are several common types of corticosteroids, including:
Corticosteroid medications are available in several forms that vary in how they are administered and how long they stay in the body. The drugs often come in both high-dose and low-dose types. Doctors administer steroids in a hospital, an infusion center or, sometimes, at home. Steroids can be taken in different ways:
Corticosteroids are used to treat people with acute MS exacerbations. During multiple sclerosis relapses, symptoms temporarily worsen or return. Relapses can persist for days or months and are often followed by remission (a period of recovery).
When taken short term, corticosteroids are safe and effective for MS flare-ups. Steroids help people improve more quickly by reducing 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. Studies show that it is best to begin steroid treatment within a week of MS-relapse symptom onset.
Intravenous methylprednisolone (IV-MP), the most commonly used steroid treatment for MS relapses, is usually given 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 dexamethasone (Decadron) instead of IV-MP. 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 gradually reduced dose for an additional one to two weeks.
Related to corticosteroids, repository corticotropin hormone (RCI, sold under the brand name Acthar Gel) is approved by the FDA to treat MS relapses. RCI, which contains a purified form of a chemical called adrenocorticotropin, works by stimulating the body to produce steroid hormones. These natural hormones, similar to corticosteroids, reduce inflammation and suppress the immune system.
RCI is injected under the skin or into muscle just once a day for two to three weeks. Studies demonstrate that RCI is as effective as corticosteroids. RCI is typically used to treat MS in people who are not able to tolerate corticosteroids or get to an inpatient facility to receive corticosteroids.
Although corticosteroids are an important tool in the management of multiple sclerosis, the treatment has several short-term and long-term side effects. Not everyone experiences these negative effects, which, when they do occur, are often mild and go away quickly once treatment ends.
Watch MS expert Dr. Aaron Boster talk about the differences between side effects and symptoms.
Potential short-term corticosteroid side effects include:
In rare cases, people have severe depression when taking steroids. Those experiencing extreme mood changes should seek medical attention as soon as possible.
Some MyMSTeam members report feeling a lump in the back of their throat when taking prednisone. One member said, “I feel like there is something in my lower throat taking up space that shouldn’t be there. I start choking on things, mostly food.”
Long-term steroid use can lead to additional side effects, including:
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.
MyMSTeam is the social media network for people with multiple sclerosis and their loved ones. Here, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Have you taken corticosteroids for MS? Did you have to manage any side effects? Share your experience in the comments below, or start a conversation on MyMSTeam.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Candace Crowley, Ph.D. received her doctorate in immunology from the University of California, Davis, where her thesis focused on immune modulation in childhood asthma. Learn more about her here.
