Background and importance An outbreak of multiple sclerosis (MS) is defined as symptoms and neurological signs typical of demyelinating disease, with a duration of at least 24 hours. It appears in all forms of MS, contributing to short and long term disability. The main treatments for outbreaks are high dose steroids given intravenously or orally for 3–5 days. In our clinical practice, we used oral prednisone 1400 mg for 5 days prepared in a hospital pharmacy to avoid staff attendance at health centres.
Aim and objectives To evaluate oral prednisone effectiveness as a treatment for acute MS outbreaks.
Material and methods This was a retrospective multidisciplinary study, from March to June 2020 (4 months), during the limited mobility period due to the coronavirus pandemic (SARS-CoV-2). The results of 31 patients were analysed. The following data were collected: sex, age, type of MS, expanded disability status scale (EDSS), treatment at the time of the outbreak, symptoms and evolution. The programmes used were: patient medical history (DIRAYA), outpatient dispensing (DOMINION) and MRI (CARESTREAM). Specialist role was: the neurologist made the clinical evaluation, the pharmacist prepared the prednisone capsules from original tablets and its dispensation, and the nurse provided patient education.
Results 31 patients (25 women) with a mean age of 44.85 ±13 years were assessed. Every patient had a diagnosis of recurrent remitting MS. Treatments were: interferon beta (20), dimethyl fumarate (10) and cladribine (1). The mean EDSS was 3. The main symptoms were: paraesthesias, muscle weakness and urinary incontinence. The EDSS progressed positively: 83.78% of patients evolved favourably, a subjective decrease in paraesthesia and weakness was observed and MRI showed less inflammation signs. Another aspect was the comfort of the patient in carrying out this treatment at home rather than attending hospital.
Conclusion and relevance The results suggested that 1400 mg of oral prednisone administration for 5 days could be considered a safe, effective and comfortable alternative treatment for acute outbreaks of MS. Multidisciplinary care is essential to obtain better clinical results.
References and/or acknowledgements
Morrow SA, McEwan L, Alikhani K, et al. MS patients report excellent compliance with oral prednisone for acute relapses. Can J Neurol Sci 2012;39:352–4. doi: 10.1017/s0317167100013500.
Conflict of interest No conflict of interest
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