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BRIEF COMMUNICATIONS: S. A. Morrow, C. A. Stoian, J. Dmitrovic, S. C. Chan, and L. M. Metz The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis Neurology 2004; 63: 1079-1080 [Abstract] [Full text] [PDF]

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The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis

Michael Strupp   (18 November 2004)

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Luanne M Metz   (18 November 2004)

The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis 18 November 2004
Michael Strupp, Department of Neurology at the University of Munich Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany Send Correspondence to journal: Re: The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis Mstrupp{at}nefo.med.uni-muenchen.de Michael Strupp	In the accompanying Editorial to this article, the question was raised why the authors did not use oral methylprednisolone instead of prednisone to even better compare the effects of both drugs. As was recently shown, oral methylprednisolone seems to be a good agent to treat other neurological disorders such as vestibular neuritis. [1] Reference 1. Strupp M, Zingler V, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004;351:354-361
Reply to Strupp 18 November 2004
Luanne M Metz, University of Calgary 12th Floor Neurosciences, Foothills Medical Centre, 1403-29th Street NW, Calgary, AB, T2N 2T9 Send Correspondence to journal: Re: Reply to Strupp lmetz{at}ucalgary.ca Luanne M Metz	Strupp poses an interesting question. Deciding which corticosteroid to administer orally was not an easy decision when designing the study. We chose oral prednisone because we had already proven its safety with respect to gastric tolerance. [1] It is the least expensive corticosteroid and oral methylprednisolone is not available in Canada. We accounted for the difference in potency between methyprednisolone and prednisone (5:4) by administering a 25% higher dose of prednisone and by considering this potency difference in our final analysis by reducing the amount of predisolone by 20% before comparing it to methyprednisolone in our paper. Given that all corticosteroids are thought to exert their glucocorticoid effects primary through the same receptor (the glucocorticoid receptor) we thought it was unlikely that it would matter which corticosteroid we evaluated. Given the lack of mineralocorticoid effect that occurs with dexamethasone, we thought that this might actually be the best alternative. However, we chose the lowest cost treatment instead. While it would be interesting to compare various formulations in a clinical trial, I have not been able to find any evidence that the various steroid formulations may have different biological effects and thus it would be very difficult to justify the additional expense. References 1. Metz LM, Sabuda D, Hilsden RJ, Enns R, Meddings JB. Gastric tolerance of high-dose pulse oral prednisone in multiple sclerosis. Neurology 1999;53:2093