Managing multiple sclerosis relapses in 2016

INTRODUCTION: High doses of intravenous methylprednisolone are recommended to treat relapses in patients with multiple sclerosis, but can be inconvenient and expensive. Until 2015, the question of efficacy and tolerability of corticosteroids in this indication remained unresolved. OBJECTIVES: The COPOUSEP study aimed to assess whether oral administration of high-dose methylprednisolone was non-inferior to intravenous administration, taking into account the advantages of an oral regimen (simpler procedure, less invasive for the patients, more convenient for a quick care response and allowing obvious savings in cost). RESULTS: COPOUSEP was the first adequately powered (200 patients), randomized, double-blind, non-inferiority trial to compare a similar dosage of oral versus intravenous methylprednisolone, given early after onset of relapse of multiple sclerosis (less than 2 weeks), taking into account the weaknesses of previous trials. Results confirmed that methylprednisolone 1 gram per day for 3 days is not less efficient orally than intravenously in terms of recovery 1 and 6 months after corticosteroids onset and in terms of new relapses up to 6 months, tolerability being similar except for more frequent insomnia for the oral regimen. DISCUSSION: These results provide strong arguments for the possibility of improving management of multiple sclerosis relapses by using oral administration, however it might increase non-specialists’ use of oral corticosteroids without consideration of the indication. In order to better prescribe the treatment, the network SEP-Bretagne provided tools written for patients and professionals involved in the procedure (neurologists and general practitioners) in order to better coordinate everyone's role. CONCLUSION: It is now possible to propose oral methylprednisolone 1 gram per day for 3 days in the treatment of multiple sclerosis relapses, but this procedure should be supervised and well coordinated between neurologists and general practitioners.