I keep hearing of oral prednisolone vs IV.

[squinun]

Hi all, I'm new here.

I was dx'd with ms in 2004 and have had minor symptoms until now - my first major flare-up - and I'm going to need some steroids.

I'm wondering how people take oral prednisone, and is that similar to oral methylprednisolone? I know of 20mg prednisone/prednisolone tablets, but I keep reading that some people opt for 1,250mg oral prednisolone per day instead of IV.

Thats an extreme amount of tablets per day. Is this correct?

Also I read that they take the oral pred over 3 weeks, then again I read that its taken as the IV would be taken i.e - over 3-5 days. Which is correct?

Pls help, thank you.

[squinun]

Technically, if you did a 3-day IVSM and then realised that you would like to do 2 days more and this is not possible and you have access to the oral prednisone, the a further 2 days of oral preds wil suffice.

Is this correct?

[MsmsinFl]

I've read several studies that the oral taper is not needed.

I had 5 days IVSM with no taper -- did perfectly fine.

[angela5674]

I just finished with a 5 day steroid infusion @ 500mg/day.  Now my dr has me on a prednisone taper down for the next 3 weeks, starting at 60mg today and ultimately ending at 5mg.  I'm not looking forward to being on steroids for the next 3 weeks, even if it is a taper down.  Does anyone have any thoughts on that?

Angela

[Lulu54]

This just illustrates how divergent the treatment plans are from doctor to doctor.  and of course it depends on the extent of the relapse.

[squinun]

Whats the difference between prednisone and methylprednisone?

[tammy197238]

My neuro put had me do 3 days of IVSM followed by 14 days of oral prednisone.  I dont remember dosages.

[rendean]

My MS neuro orders oral 1 gram of oral methylprednisone  x 3 days and has the studies to prove it on hand.  He frequently orders it but your math is correct, it's a lot of pills.

Ren

[squinun]

I called my neuro today and he told me that IVMP is better than oral MP as it goes to work faster and therefore he assumes it will be more effective.

[Lulu54]

My MSologist says there is no difference in effectiveness between oral and IV and the studies bear that out.

You are not silly at all in doing the math. It takes a lot of standard prednisone to get to the mega doses we need.   I have been on steroids twice - the first time we jump started it with an IV treatment in their office and then two days of oral.  The second time was straight oral.  I prefer the oral route for the convenience of not having to be tied to an IV,  and the pill I take is Decadron.  The version I take is made at a compounding pharmacy that my neurologist is confident will make the drug right.

Their pharmacist puts into one capsule the drug that is equivalent to 25 prednisone tabs.  It is much easier on the stomach. You can read more about it at:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000773/

[squinun]

Thanks for your post. How exactly is 1,250mg of oMP taken? Am I silly in thinking one would take 20 tabs of 20mg three times a day, or 60 tablets at one go of 20mg each? In my head this seems way crazy!

[doublevision1]

http://www.neurology.org/content/73/22/1842.abstract



A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS

V. Martinelli, MD, M. A. Rocca, MD, P. Annovazzi, MD, A. Pulizzi, MD, M. Rodegher, MD, F. Martinelli Boneschi, MD, R. Scotti, MD, A. Falini, MD, M. P. Sormani, PhD, G. Comi, MD and M. Filippi, MD
+ Author Affiliations

From the Department of Neurology (V.M., M.A.R., P.A., A.P., M.R., F.M.B., G.C., M.F.), Neuroimaging Research Unit (M.A.R., M.F.), Institute of Experimental Neurology, Division of Neuroscience, and Department of Neuroradiology (R.S., A.F.), Scientific Institute and University Ospedale San Raffaele, Milan; and Health Sciences Department (M.P.S.), University of Genoa, Genova, Italy.


Abstract

Objective:
To compare the efficacy, tolerability, and safety of IV methylprednisolone (IV MP) vs oral methylprednisolone (oMP) at equivalent high doses in patients with multiple sclerosis (MS) experiencing a recent relapse.


Methods:
Patients with a clinical relapse within the previous 2 weeks and at least 1 gadolinium (Gd)-enhancing lesion on a screening brain MRI scan were included. Forty patients with MS were randomized to receive either 1 g/day for 5 days of oMP (20 patients) or 1 g/day for 5 days of IV MP (20 patients). Expanded Disability Status Scale (EDSS) and brain MRI (dual-echo and postcontrast T1-weighted scans) were assessed at baseline and at weeks 1 and 4. The study primary research question (endpoint) was to compare the efficacy of the 2 treatment routes in reducing the number of Gd-enhancing lesions after 1 week from treatment initiation. Secondary outcomes were safety, tolerability, and clinical efficacy profiles of the 2 routes of administration.


Results:
The 2 groups showed a reduction of Gd-enhancing lesions over time (p = 0.002 for oMP and p = 0.001 for IV MP) with a “non-inferiority effect” between the 2 routes of administration at week 1. Both groups showed an improvement of EDSS over time (p < 0.001) without between-group difference at week 4. Both treatments were well-tolerated and adverse events were minimal and occurred similarly in the 2 treatment arms.


Conclusions:
Oral methylprednisolone (oMP) is as effective as IV methylprednisolone in reducing gadolinium-enhancing lesions in patients with MS soon after an acute relapse with similar clinical, safety, and tolerability profiles.

This study provides class III evidence that 1 g oMP × 5 days is not inferior to 1 g IV MP × 5 days in reducing the number of gadolinium-enhancing lesions over a period of 1 week (mean difference in lesion reduction comparing IV MP to oMP is −20%, 95% confidence interval −48% to + 5%).

[wildcat2x]

Hello.  I don't know too much about taking 1250 mg of predisone.  I had to take 80mg (20 mg 4 times a day) for about 2 weeks after 4 days of the IV steriod in the hospital.  With a high dosage you might find your doctor tapering the dosage.  I have known people who have taken a higher dosage.

[Deb61]

Here's an article about the treatment of MS flare-ups with steroids.  There's a major double-blind study, that just can out in January this year, to determine which is best for MS flares.  Right now, the treatment of choice, as noted in the article, is still IV steroids.  Also, note that although the steroids (with the exception of optic neuritis), the steroids only reduce the flare-up time and not the outcome.  

http://www.msif.org/en/resources/msif_resources/msif_publications/ms_the_guide_to_treatment_and_management/treatment_for_an_acute_exacerbation/index.html

I don't know about the dosage.  Maybe someone can help you that has recently been on the medicine . . .