We found one small RCT (31 people, 24 with clinically definite multiple sclerosis, 6 with probable multiple sclerosis, and 1 who developed clinically probable multiple sclerosis during follow-up) comparing dexamethasone versus high- and low-dose methylprednisolone, all given intravenously.  People were randomised to receive either: dexamethasone (8 mg/day for 7 days, 4 mg/day for 4 days, then 2 mg/day for 3 days); low-dose methylprednisolone (40 mg/day for 7 days, 20 mg/day for 4 days, then 10 mg/day for 3 days); or high-dose methylprednisolone (1 g/day for 3 days, 500 mg/day for 3 days, 250 mg/day for 3 days, 125 mg/day for 3 days, then 62.5 mg/day for 2 days).The RCT measured mean change in Expanded Disability Status Scale (EDSS) score as a primary outcome. The RCT found a slightly higher mean EDSS change at 15 days with dexamethasone compared with low- and high-dose methylprednisolone, but this difference was not statistically significant (mean change in EDSS score presented graphically; proportion of people with a change in EDSS score by at least one point; 10/11 [91%] with dexamethasone v 8/10 [80%] with high-dose methylprednisolone v 6/10 [60%] with low dose methylprednisolone; difference reported to be not significant; P value not provided). One month after treatment stopped, a greater proportion of people in the dexamethasone and high-dose methylprednisolone groups were in remission compared with low-dose methylprednisolone (10/11 [91%] with dexamethasone v 9/10 [90%] with high dose methylprednisolone v 4/10 [40%] with low dose methylprednisolone; significance not assessed).
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