Growing Preference for Oral Steroids in Treating MS Relapses

In recent years, the medical community has observed a notable trend in the treatment of relapses associated with relapsing-remitting multiple sclerosis (RRMS): an increasing preference for oral steroids over intravenous (IV) steroids. This shift was highlighted in a study presented at the Canadian Neurological Sciences Federation (CNSF) Congress 2025, where researchers analyzed data from 2010 to 2022, revealing significant insights into treatment modalities for MS relapses.

According to Dr. Jihad Al Kharbooshi, a fourth-year adult neurology resident at the London Health Sciences Centre in Ontario, the study reviewed data from the MuSicaL MS database, identifying 2,413 eligible patients, of whom 1,086 experienced at least one attack or relapse. Among these patients, a substantial number—543—had utilized high-dose steroids for 818 attacks. Notably, the data indicated that oral steroids were administered in 208 cases (59.8%), while IV steroids were used in 148 cases (42.5%). This growing reliance on oral steroids is attributed to their equivalent efficacy compared to their IV counterparts, a finding supported by previous studies.

Dr. Al Kharbooshi noted, "Both IV and oral steroids have been shown to possess comparable efficacy in managing MS relapses. However, the choice of steroid administration often hinges on the perceived severity of the relapse. For instance, those patients experiencing multifocal relapses—considered more severe—were more likely to receive IV steroids (39.3%) compared to oral (25.5%)." This suggests a clinical tendency to opt for IV administration in what are perceived as life-threatening situations.

The study further explored whether the specialty of the prescriber influenced the choice between oral and IV steroids, concluding that the prescriber’s specialty—whether a neurologist or another type of healthcare provider—did not significantly impact the treatment route chosen.

Dr. Maryam Nouri, an associate professor of pediatric neurology at Western University, who moderated the session, offered insights into the broader implications of this trend. She remarked, "The declining reliance on steroids for managing MS relapses likely reflects the effectiveness of newer therapies available for RRMS, which may be reducing the overall frequency of relapses. This evolving treatment landscape indicates that many patients are beginning their therapy with high-affinity agents, resulting in fewer relapses that necessitate steroid intervention."

Despite the positive implications of the study, limitations were acknowledged, particularly regarding the missing data on the route of steroid administration for many relapses. Dr. Nouri commented, "While the data suggests an increasing comfort level with oral steroids among clinicians, in pediatric cases, IV steroids remain the preferred method due to the existing evidence primarily stemming from adult studies."

The implications of this shift in treatment strategy are profound, as the increased use of oral steroids offers greater accessibility, particularly for patients residing in remote areas, where access to IV therapy may be challenging. As medical professionals adapt to this trend, the focus will likely continue to evolve, emphasizing patient convenience without compromising efficacy.

The study was conducted without external funding, and Dr. Al Kharbooshi and Dr. Nouri reported no relevant financial relationships. The findings contribute to a growing body of evidence supporting the use of oral steroids in managing MS relapses, marking a significant development in neurologic treatment protocols.