Corticosteroids, also called glucocorticoids or steroids, are drugs that are designed to mimic cortisol, a hormone produced by the adrenal glands that has anti-inflammatory effects. Corticosteroids are used to manage acute exacerbations or relapses in people with MS.1
There are several different brands of corticosteroids used in MS, formulated for intravenous and/or oral administration, including methylprednisolone (brand: Solu-Medrol®), dexamethasone (brand: Decadron), prednisone (brand: Deltasone), prednisolone (brand: Orapred), and betamethasone (brand: Celestone).
How do corticosteroids work?
Corticosteroids suppress multiple inflammatory pathways in the body, including genes that are responsible for producing cytokines, enzymes, receptors and proteins that are activated during the inflammatory process.2 Because MS exacerbations or relapses involve nerve damage caused by inflammation in the central nervous system (CNS), the goal of corticosteroid treatment is to control that inflammation and halt acute damage.3
How are corticosteroids taken?
High-dose corticosteroids are frequently used for acute MS relapses. In most cases, an intravenous (IV) injection of methylprednisolone is given for 3-5 days. This may be followed by a tapering dose of oral corticosteroids for 1-2 weeks.1,3
How effective are corticosteroids?
Corticosteroids have been used in MS treatment since the 1940’s, and their anti-inflammatory effect has been established in many studies. However, MS is a highly individualized disease, with no two people having the exact same experience or symptoms. There is great variability in the severity of relapses and the degree to which relapses respond to corticosteroid therapy. The research studies that have been conducted on corticosteroids vary, because not everyone initiates treatment with corticosteroids as soon as the relapse symptoms begin, so it’s difficult to predict how fast or how completely corticosteroids will work for the individual.3
In addition, corticosteroid treatment is often used repeatedly over the course of an individual’s disease, and the response from one treatment to the next can vary even for the individual. Just because corticosteroids were effective once does not necessarily mean they will be effective in future relapses. The response to corticosteroids often decreases over time.3
What are the possible side effects of corticosteroids?
Corticosteroids are strong medicines that are associated with a range of side effects, including:3,4
- Gastrointestinal disturbances, including peptic ulcers, inflammation in the stomach (gastritis) that may cause pain or nausea, and an unpleasant metallic taste in the mouth
- Changes in mood, including depression, irritability, abnormally happy (euphoria), or anxiety
- Water retention and weight gain
- Elevated blood sugar levels
- Elevated blood pressure
- Difficulty sleeping
- Changes in heart rhythm
- Thinning of bone tissue (osteoporosis)
- Increased risk of infection
- Eye problems, including cataracts or glaucoma3,4
These are not all the possible side effects of corticosteroids, and patients should talk to their doctor for more information.
Other precautions of corticosteroids
There are certain medications, including blood thinners, antiepileptic drugs, oral contraceptives, and non-steroidal anti-inflammatory drugs (NSAIDs), that can cause negative interactions if used with corticosteroids.5 Before starting treatment with corticosteroids, patients should talk to their doctor about all their medications, vitamins, and supplements.
Corticosteroids should be used with caution in pregnant women and should only be used in pregnant women if the benefits outweigh the risks. While there have been no adequate studies of corticosteroids in pregnant women, animal studies have shown an increase in birth defects.5 Corticosteroids do cross into the breast milk of women who are nursing and may have harmful effects on a nursing child.
Before starting treatment with corticosteroids, patients should talk to their doctor about all their health conditions, especially if they have heart and kidney problems, diabetes, infections, glaucoma, or cataracts.5