IV Steroids in the treatment of acute relapse in MS
Do people with MS prefer treatment in outpatient or home setting?
National Hospital for Neurology & Neurosurgey, London
Intravenous (IV) steroids are routinely used to treat disabling relapses in multiple sclerosis, and can be administered in an out-patient or home setting. However the two strategies have not been compared formally in a trial setting before.
An appropriate rating scale, measuring patients' experiences of relapse management was developed as the primary outcome measure. A randomised controlled trial of outpatient versus home treatment was performed in patients having a clinically significant relapse within four weeks of onset. The efficacies of the two treatment methods were compared in terms of traditional measures, and economic cost.
Of 149 eligible patients, 138 consented to the trial and were randomised into the two arms. The home treatment group had a significantly better patient experience of relapse management in terms of co-ordination of care which took into account the comfort of the setting and convenience. Steroids were equally safe and effective in either location and cost was either the same or cheaper when delivered at home than when in hospital.
In the treatment of relapses, there is now good evidence for intravenous steroids to be given at home, from both patient and economic perspectives. Moreover the trial demonstrates the importance of an explicit and valid outcome measure which reflects all aspects of service delivery when making decisions on health policy. This has implications for complex service delivery care models in long-term conditions.
The MS Trust is delighted to have funded this important study. It shows that rapid and effective access to treatment in relapse is critical and it puts patient choice at the centre of the decision about relapse care. By demonstrating the potential for NHS cost savings, we hope that in time this research will translate into development of services that offer real choice for people with MS.
Published papers
Chataway J, Porter B, et al.
Home versus outpatient administration of intravenous steroids for multiple-sclerosis relapses: a randomised controlled trial.
Lancet Neurology 2006;5(7):565-571.
Medline abstract
Harrison E, Porter B.
IV steroids for MS relapse: clinical governance implications.
British Journal of Nursing 2006;15(13):716-721.
Medline abstract
Matheson F, Porter B.
The evolution of a relapse clinic for multiple sclerosis: challenges and recommendations.
British Journal of Neuroscience Nursing 2006;2(4):180-186.
