Chronic treatment with glucocorticoids has failed to demonstrate a beneficial effect on either the progression of disability or the rate of relapse. In addition, it may induce severe adverse effects, including osteoporosis, aseptic bone necrosis, proximal muscle weakness, hypertension, hyperglycemia, cataracts, and psychiatric events. One recent randomised trial found that patients who received regularly scheduled corticosteroid treatments (1 g IV methylprednisolone for five days, followed by four days of prednisone [50 mg and 25 mg for two days, each] every four months for three years, and then twice yearly for two years) were less likely to develop MRI evidence of brain atrophy, clinical evidence of progressive disability, or convert from relapsing to SPMS than were patients treated “as needed” with corticosteroids. This study is of potential interest but has not been confirmed to date.

In the opinion of the Committee, chronic therapy with corticosteroids is contraindicated in MS because of lack of efficacy and reported harmful effects (for pulse treat- ment with steroids see Chapter 2).