Long and short lasting side effects of high dose methylprednisolone pulse therapy in multiple sclerosis. A study on 1527 courses

It is widely known that high dosage of methylprednisolone treats relapses of multiple sclerosis, even in patients who are receiving other drugs, such as interferon. In general, short and long term adverse effects of corticosteroids used in autoimmune disorders are well known. Though, as far as we know, there are only two studies in literature which evaluate side effects of high dosage of methylprednisolone in multiple sclerosis (MS). Our aim was to evaluate our MS population, composed by 211 patients, following it during a period of 8 years of treatment; we analysed 1527 therapy cycles and we underlined immediate and late side effects of this therapy from a clinical and a laboratoristical point of view. The results were interesting, considering the low number of drop out from the therapy in a huge number of patients. Only 7 subjects (3.3%) interrupted the therapeutic program due to potentially dangerous side effects, such as bone demineralisation and fractures, psychotic reaction, glomerulonephritis, urinary sepsis and severe mucositis. In general, all the other side-symptoms related to steroid treatment reported in our study (such as insomnia, pyrosis, anxiety, asthenia, pollakiuria, acneiformis eruption) are quite easily sufferable, easily detected and explained and moreover reduced or disappeared immediately after the withdrawal of the steroid therapy. As a conclusion, this study supports the evidence that high dosage MP, a chance for MS treatment, in particular of relapses, determine side effects, even in prolonged administration, which are much more sufferable, expectable and not so dangerous as those reported by other immunomodulant or immunosuppressive treatments.