Treating MS With Steroids

There are two sides to treating Multiple Sclerosis and though the goals may seem like they are pretty much the same thing (reducing symptoms) they really aren't. First there is the management of the course of the disease itself through the use of Disease Modifying Drugs (DMD's). Hopefully when a DMD is working well you will not experience many symptoms that can't be managed with things like prescription medication or life style changes. Secondly there is the management of the symptoms that appear when having a flare-up or relapse. When this happens, how do you "make it go away" so you can go back to feeling stable on your DMD?

This is the most typical course of action; it's what you do if you are playing it by the books. Now what do I mean when I say steroids? Well, not what you’re probably thinking, not the horse hormones that bodybuilders illegally use to build muscle mass. No, I am talking about medical steroids that are used to reduce inflammation, the main cause of flair ups in Multiple Sclerosis. When you are experiencing a flare up (or a relapse) your body is experiencing inflammation in the central nervous system; this inflammation damages the myelin sheath along your nerves (creating new lesions/plaques), which ultimately may cause more symptoms. The damage inflammation causes slows down (or even disrupts) the transmission of nerve impulses, which is what causes all the symptoms of MS. So in other words, inflammation is bad for MS! Ending the body's inflammatory response can eliminate symptoms whether this means all of your symptoms, most of your symptoms, or some of your symptoms; everyone is different. Steroids are used to reduce that inflammation.

There are three types of steroids that are generally used to treat Multiple Sclerosis that I will be talking about and they include oral medication, intravenous (IV) medication, and injections.

Oral Medication - Prednisone
Prednisone is an artificial steroid that comes in oral tablets of various dosages from 1mg to 20mg tablets. They taste horrible... Your neurologist will come up with a taper plan for taking Prednisone meaning, you may start off on 60mg for a week, then 50mg the next week, then 40mg, then 30mg, and so on until you are off the medication. Some people can taper off Prednisone faster than others so it will be up to you and your doctor to determine the appropriate taper rate.

Common Side Effects
Intravenous (IV) Medication - Solu-Medrol (Methylprednisolone)
Solu-Medrol is another artificial steroid that is administered via an IV. It is usually given at 1,000mg (1 gram) over the course of an hour for 3-5 days depending on how well you tolerate the medication and what your doctor believes is best for you. Sometimes your doctor may have you taper off Solu-Medrol with oral Prednisone tablets after your infusion since both medications are basically the same thing.

Common Side Effects
 Injection - HP Acthar Gel
Acthar was actually used before Prednisone and Solu-Medrol became available. It is self administered with either a subcutaneous (under the skin) needle or an intramuscular (into the muscle) needle usually at about 1ml a day for 10 days. Acthar is usually used for people who react poorly to Prednisone or Solu-Medrol or who no longer respond to these steroids. It is hardly ever used anymore because it is not synthetic (Acthar is a medication that uses a hormone called ACTH that naturally appears in the body to engage the production of cortisol, the stress hormone) which means it is not cheap. 

Acthar comes in a vial that must be kept refrigerated in between uses and each 5ml vial runs at about roughly $28,000 USD (The New York Times, 2012) so if your doing 10ml a month (2 vials) that equals about $56,000 USD a month! Compared to around $960 USD for 5 days of Solu-Medrol (JAAC) or the even cheaper oral Prednisone you can easily find online for as low as 48 cents per 20mg tablet, it is no wonder no one wants to prescribe Acthar anymore!

Common Side Effects
I have used Acthar for quite a while (since it might not be a great idea to take steroids while on Tysabri) and I have never experienced any side effects whatsoever. Even with Prednisone and Solu-Medrol I experienced most of the common side effects so I personally love Acthar. 
My first “MS Specialist” in Colorado said he has never seen any research that shows it actually works (despite my testimony) and therefore sees no point in charging the insurance company so much money. He refused to prescribe it. I plan to send him a copy of this document; 

Use of Acthar GEL for MS Exacerbations During Natalizumab Induction and Maintenance.