Monday June 14, 2004
Boston Cure Project
A group of German neurologists has published a thought-provoking paper concerning patients' involvement in the decision to treat MS attacks with corticosteroids. Using steroids in the early stages of a relapse is a common practice; however, very few randomized clinical trials have been performed to determine how effective and safe this type of therapy is. A previous Cochrane review of steroid treatment studies found only six trials to review; based on results from these trials, the reviewers concluded that approximately 1 in 4 patients on steroid therapy would experience a shorter period of disability because of the treatment. The evidence is even more limited on other aspects of treatment such as optimal administration (dosing, frequency, route, timing), harmful side effects, or other possible benefits such as prevention of future relapses. The authors of this paper concur with the Cochrane reviewers that the lack of evidence on steroid therapy is unfortunate and even surprising given the size of the effect relapses can have on people with MS, and the prevalence of the use of this therapy.
Because of the lack of data and the many areas of uncertainty, the authors of this study contend that whether to administer corticosteroids for relapses is a decision that calls for a high degree of patient involvement. Their observation of current clinical practice is that patients tend to feel obligated to undergo steroid therapy at the recommendation of their doctor, but are personally ambiguous and uncertain about this approach. The authors believe that a more formal shared decision-making process, supported by educational materials that inform patients about the factors to consider, would be beneficial in these situations. They are currently working on such materials, based on the limited trial evidence available. They also state that people with MS should not feel guilty about either declining steroid treatment for relapses or taking time to decide what to do.
Having read this paper, it seems to me that people with MS might be
well-advised to research the pros and cons of steroid therapy and discuss
them with their doctors -- before their next relapse if possible. That
way they can take plenty of time to evaluate the data, understand their
doctors' opinions on the topic, and perhaps come to some conclusions, free
from the pressure of having to make a quick decision.
Copyright © 2004, Boston Cure Project