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My neuro strongly believes that dexamethasone is preferable to oral or even IV prednisone in treating relapses. Protocol that he has used is similar to what the paper talks about - 4 mg qds for 5 days...
Dexamethasone, like prednisone - is an anti inflammatory.
My Dr prefers to use dexamethasaone to treat MS relapses because he believes it is as effective if not more effective than prednisone with fewer side effects. Additionally an entire course of dexamethasone can be given orally in a home setting, unlike IVSM which must be infused in a clinic or hospital.
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. [43] 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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