A Cochrane review [Abstract] 1 included 6 RCTs with a total of 377 patients with multiple sclerosis. Patients were randomised within 8 weeks after the onset of symptoms of relapse. Methylprednisolone (MP) was studied in 4 trials and ACTH in 2 trials. MP dosing ranged from 500 mg orally for 5 days to 1000 mg intravenously for 5 days with tapering doses in 2 trials. ACTH dosing was 40 UI twice daily (td) intramuscularly (im) for 7 days, and then tapering doses for a week in the other trial and 60 UI td im for 7 days, 40 UI td for 7 days, and then tapering doses for the third week in another trial. Overall, MP and ACTH showed a protective effect against the disease getting worse or not getting better within the first 5 weeks of treatment (OR 0.37, 95% CI 0.24 to 0.57) with some but non-significant greater effect for MP and iv administration. Short (5 days) or long (15 days) duration of treatment with MP did not show any significant difference. In the one trial (n=51) assessing long-term outcome (1 year), no difference between MP and placebo was detected in the prevention of new exacerbations or improvement in long-term disability.
Comment: The quality of evidence is downgraded by sparse data.
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