Corticosteroids

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 multiple sclerosis (MS).¹

There are several different brands of corticosteroids used in MS, formulated for intravenous and/or oral administration, including:

• Methylprednisolone (Solu-Medrol®)
• Dexamethasone (Decadron)
• Prednisone (Deltasone)
• Prednisolone (Orapred)
• Betamethasone (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 1940s, and their anti-inflammatory effect has been established in many studies. However, MS is a highly individual 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.³

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
• Acne
• Changes in heart rhythm
• Thinning of bone tissue (osteoporosis)
• Increased risk of infection
• Eye problems, including cataracts or glaucoma^3,4

These are not all the possible side effects of corticosteroids. Talk to your doctor about what to expect when taking corticosteroids. You also should call your doctor if you have any changes that concern you when taking corticosteroids.

Other precautions of corticosteroids

Certain medicines, including blood thinners, antiepileptic drugs, oral contraceptives, and non-steroidal anti-inflammatory drugs (NSAIDs), can cause negative interactions if used with corticosteroids. Before starting treatment with corticosteroids, talk to your doctor about all the drugs, vitamins, and supplements you are taking. This includes over-the-counter drugs.5

If you are pregnant, corticosteroids should be used with caution and only if the benefits outweigh the risks. While there have been no adequate studies of corticosteroids in pregnancy, animal studies have shown an increase in birth defects. Corticosteroids do cross into breast milk and may have harmful effects on a nursing child.⁵

Before starting treatment with corticosteroids, talk to your doctor about all your health conditions, especially if you have heart and kidney problems, diabetes, infections, glaucoma, or cataracts.⁵