A Cochrane review [Abstract] 1 included 3 studies with a total of 183 subjects. Corticosteroid therapy did not reduce the risk of being worse at the end of follow-up (OR 0.51, 95% CI 0.26 to 1.02; 2 studies, n=136). There was substantial heterogeneity between the two trials (I2 78.4%). Intravenous periodic high dose methylprednisolone was associated with a significant reduction in the risk of disability progression at 5 years in relapsing-remitting MS (OR 0.26, 95% CI 0.10 to 0.66; 1 study, n=81), while oral continuous low dose prednisolone was not associated with any risk reduction in disability progression at 18 months (OR 1.23, 95% CI 0.43 to 3.56; 1 study, n=55). Risk of experiencing at least one exacerbation at end of follow-up was not significantly reduced with corticosteroid treatment (OR 0.36, 95% CI 0.10 to 1.25; 2 studies, n=107). Only one study recorded adverse events: in one patient intravenous methylprednisolone was discontinued after the fourth pulse when he developed acute glomerulonephritis; a second patient was removed from the study after the fifth pulse because of severe osteoporosis.
Comment: The quality of evidence is downgraded study quality (inadequate intention-to treat adherence and lack of blinding) and by imprecise results (limited study size for each comparison) and upgraded by large magnitude of effect.
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