Glucocorticoids for multiple sclerosis
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What are glucocorticoids?
A type of corticosteroids, glucocorticoids are hormones often used in the treatment of inflammatory and autoimmune disorders due to their powerful anti-inflammatory and immunosuppressive properties.
Glucocorticoids play a role in a wide range of physiological functions in the human body, including in the immune response, stress response, metabolism (how cells use carbohydrates, fat, and proteins), and regulation of inflammatory processes, among others.
Naturally occurring glucocorticoids produced by the body include cortisol, also referred to as hydrocortisone. Several synthetic or man-made glucocorticoids, such as prednisone and methylprednisolone, have been developed to mimic the naturally occurring compounds but with improved potency and specificity.
Therapy Snapshot
| Brand Name: | Rayos, Solu-Medrol, Dexamethasone Intensol, among others |
| Chemical Name: | Prednisone, methylprednisolone, dexamethasone, among others |
| Usage: | Relapse management therapies for acute MS exacerbations |
| Administration: | Variable according to the specific therapy |
How do glucocorticoids work in MS?
In multiple sclerosis (MS), glucocorticoids are useful for managing acute disease exacerbations or relapses — periods when symptoms suddenly get worse. According to the National MS Society, most neurologists recommend a short course of treatment with high-dose corticosteroids to reduce inflammation and quickly resolve severe disease relapses.
The most common glucocorticoids used in the treatment of MS are:
- prednisone, sold under several brand names, including Rayos
- methylprednisolone, available as several brands, including Solu-Medrol
- dexamethasone, sold under several brand names, including Dexamethasone Intensol
Of note, while glucocorticoids can help in the management of acute relapses, they do not seem to affect MS progression or the overall disease course.
Glucocorticoids have inhibitory effects on cells of the immune system. They bind to protein receptors, called glucocorticoid receptors, at the surface of immune cells, thereby dampening the inflammatory activity of these cells and reducing the levels of pro-inflammatory molecules.
Treatment with glucocorticoids also is believed to reduce the permeability of blood vessels, such as those that form the blood-brain and blood-spinal barriers — highly selective barriers that prevent the entry of certain compounds and immune cells into the brain and spinal cord, respectively. This results in fewer inflammatory cells reaching the central nervous system, which would otherwise potentially cause damage and inflammation; however, it also blocks medications from reaching their intended target.
Who with MS can take glucocorticoids?
Several glucocorticoids are approved by the U.S. Food and Drug Administration (FDA) for the management of acute relapses in MS. These therapies are typically only used for relapses that cause significant problems — such as those that affect vision, interfere with daily function, or cause significant impairment.
Mild relapses, including those characterized by non-disabling sensory symptoms, may not require intervention with glucocorticoids as the risk of treatment may outweigh the potential benefit, given the medications’ potential side effects. Treatment decisions should be made by healthcare professionals based on each patient’s particular case.
Glucocorticoids may be used in children, although there is evidence that they can impair a child’s growth and development; therefore, the use of such medications in this particular age group must be carefully planned and monitored.
Who should not take glucocorticoids?
People with known hypersensitivity to glucocorticoids or any inactive ingredients (excipients) in their formulation should not receive these treatments. Some glucocorticoids also are contraindicated for, or should not be taken by, people with systemic fungal infections and those with cerebral malaria.
How are glucocorticoids administered in MS?
Glucocorticoids are available in different doses, treatment regimens, and formulations — specifically, oral medications and intravenous (into-the-vein) infusions. They should be given according to the manufacturer’s instructions and as prescribed by healthcare professionals.
There is no standard protocol on how these corticosteroids should be applied in the management of MS relapses. Healthcare providers usually tailor the treatment regimen to each patient’s needs, based on weight, disease severity, and response to treatment.
Treatment regimens can vary between MS centers, and they may include the administration of more than one glucocorticoid.
Typically, MS patients receive a high-dose treatment for several days to control acute relapses, followed by a “tapering off” period in which they are gradually given lower doses — this is important to avoid withdrawal effects associated with suddenly stopping corticosteroid treatment.
| Administration | Varies depending on specific therapy |
| Dosage | Varies according to treatment |
| Timing | Based on specific treatment regimen |
Common side effects of glucocorticoids
The use of glucocorticoids can be associated with complications and side effects, which are often related to the dose used and the duration of treatment.
The most common side effects reported for glucocorticoids include:
- fluid retention
- behavioral and mood changes
- changes in blood sugar levels
- high blood pressure
- increased appetite
- weight gain
- stomach irritation (indigestion)
Behavioral and mood changes may include euphoria, insomnia, mood swings, severe depression, changes in personality, and psychosis.
Sugar (glucose) levels should be monitored during long-term use of glucocorticoids as they can raise these levels and potentially trigger diabetes. Blood pressure and weight also should be monitored.
Of note, live or live-attenuated vaccines should not be given to patients receiving immunosuppressive doses of glucocorticoids.
Infections
Glucocorticoids can increase the risk of infection because of their suppressive action over the immune system. That can increase susceptibility to new infections and also the risk of worsening or reactivation of latent infections.
Abnormal endocrine function
Treatment with glucocorticoids can cause hormonal issues by suppressing certain endocrine pathways. Their use has been associated with the development of Cushing’s syndrome — characterized by an excess of the hormone cortisol in the body. Patients should be monitored for these conditions if glucocorticoids are used long term.
Risk of tears/perforations
People with certain gastrointestinal disorders might have an increased risk of gastrointestinal perforation, or a tear in the gut, when treated with glucocorticoids. Some glucocorticoids also may increase the risk of a tear in the heart in people who experienced a recent heart attack.
Decreased bone density
Long-term use of glucocorticoids can interfere with calcium regulation and absorption, which can result in decreased bone formation and growth, especially in children and adolescents. It also can lead to the development of osteoporosis — a condition that weakens bones and makes them susceptible to fracture — at any age.
Ophthalmic issues
Prolonged use of glucocorticoids may lead to ophthalmic problems including cataracts, eye infections, and glaucoma with possible damage to the optic nerves.
Risk in pregnancy
According to animal studies, these treatments can cause harm to a developing fetus. Glucocorticoids also can be found in breast milk and cause unwanted effects in nursing infants. Therefore, patients who are pregnant or breastfeeding are advised to discuss the use of glucocorticoids with their healthcare providers. The general rule is that this type of therapy should only be used at these times if their potential benefit justifies the potential risks.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about Glucocorticoids
Several glucocorticoids are approved by the U.S. Food and Drug Administration to help in the resolution of acute relapses of multiple sclerosis. Glucocorticoids have powerful anti-inflammatory and immunosuppressive properties that can help ease relapse symptoms, but they do not seem to have an impact on overall disease progression. Those most commonly used in MS are prednisone, methylprednisolone, and dexamethasone.
Glucocorticoids in animal studies have been shown to cause harm to a developing fetus. Therefore, patients who are pregnant are advised to discuss the use of glucocorticoids with their healthcare providers so as to carefully weigh the potential benefits and risks in their particular case.
Alcohol consumption can potentially worsen the side effects of glucocorticoid treatment or increase the likelihood that they occur. Patients are therefore recommended to seek medical advice from their healthcare team on the combination of alcohol and corticosteroids.
It is difficult to predict when and if patients will respond favorably to glucocorticoids, both in terms of therapeutic response and tolerability. This response depends, in part, on the type of glucocorticoid given, its dose, regimen, and administration method. Typically those administered intravenously (into the vein) act more quickly in providing symptom relief. In MS, glucocorticoids are prescribed to solve acute relapses; therefore, they tend to be fast-acting. Most patients usually feel an easing of symptoms within a few days of treatment; however, each person may respond differently to treatment, and some may even fail to respond adequately. Patients should follow up with their healthcare team if they have questions about the effects of the prescribed treatment.
Increased appetite and weight gain are listed as common side effects of treatment with glucocorticoids. Some of these medications also may contribute to hair loss — thinning of the scalp hair is listed as a possible side effect on the prescribing information label of several glucocorticoids.
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