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. 2025 Nov 13;96(12):1185-1193.
doi: 10.1136/jnnp-2025-336343.

Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

Jodie I Roberts  1   2 , Sifat Sharmin  2   3 , Dana Horakova  4 , Eva Kubala Havrdova  4 , Serkan Ozakbas  5 , Alessandra Lugaresi  6   7 , Valentina Tomassini  8   9 , Raed Alroughani  10 , Katherine Buzzard  11 , Olga Skibina  11   12 , Cavit Boz  13 , Recai Turkoglu  14 , Davide Maimone  15 , Bassem Yamout  16 , Samia Joseph Khoury  17 , Daniele Spitaleri  18 , Jeannette Lechner-Scott  19   20 , Marc Girard  21 , Pierre Duquette  21 , Abdullah Al-Asmi  22 , Radek Ampapa  23 , Matteo Foschi  24   25 , Andrea Surcinelli  24 , Francesco Patti  26   27 , Vincent Van Pesch  28   29 , Cristina Ramo-Tello  30 , José Luis Sánchez-Menoyo  31   32 , Ayse Altintas  33 , Pierre Grammond  34 , Elisabetta Cartechini  35 , Tunde Csepany  36 , Guy Laureys  37 , Barbara Willekens  38 , Izanne Roos  2   3 , Tomas Kalincik  2   3 , MSBase Study Group  39
Affiliations

Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years

Jodie I Roberts et al. J Neurol Neurosurg Psychiatry. .

Abstract

Background: Corticosteroid treatment of multiple sclerosis (MS) relapses is assumed to improve the speed of relapse recovery, without modifying long-term disability risk. We aimed to re-evaluate this assumption in a large cohort of individuals with MS.

Methods: Individuals with clinically definite MS and ≥3 Expanded Disability Status Scale (EDSS) measurements over ≥12 months were identified within the international neuroimmunology registry MSBase. Individuals were required to have ≥1 relapse, with complete information on relapse treatment, phenotype and severity for all documented relapses. The primary outcome was disability worsening confirmed over 12 months. The association of the cumulative number of steroid-treated and untreated relapses (as a time-varying exposure) with disability worsening was evaluated with Cox proportional hazards.

Results: In total, 3673 individuals met the inclusion criteria (71% female, mean age 38 years, mean disability EDSS step 2); 5809 relapses (4671 treated/1138 untreated) were captured (annualised relapse rate 0.19). Over the study period (total 30 175 person-years), 32.7% reached the outcome of confirmed disability worsening (median survival time 5.2 years). Non-treated relapses were associated with a higher risk of disability worsening (HR 1.72, 95% CI 1.57 to 1.88) than steroid-treated relapses (HR 1.50, 95% CI 1.43 to 1.57). This association was modified by the efficacy of disease-modifying therapy at the time of relapse.

Conclusions: Our results suggest that a lack of steroid treatment of MS relapses is associated with a higher risk of future disability worsening. Hence, corticosteroid treatment of MS relapses may impact not only the speed of recovery but also the severity of residual structural damage.

Keywords: CLINICAL NEUROLOGY; DEMYELINATING DISEASES; EVIDENCE-BASED NEUROLOGY; MULTIPLE SCLEROSIS.

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Conflict of interest statement

Competing interests: JIR served on a scientific advisory board for Amgen and received conference travel support and/or speaker honoraria from EMD Serono, Novartis and Roche. SS has nothing to disclose. DH was supported by the Charles University: Cooperation Programme in Neuroscience, by the project National Institute for Neurological Research (Programme EXCELES, ID Project No. LX22NPO5107) - Funded by the European Union ñ Next Generation EU, and by General University Hospital in Prague project MH CZ-DRO-VFN64165. She also received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, Roche and Teva, as well as support for research activities from Biogen Idec. EKH received honoraria/research support from Biogen, Merck Serono, Novartis, Roche and Teva; has been member of advisory boards for Actelion, Biogen, Celgene, Merck Serono, Novartis and Sanofi Genzyme; received honoraria/research support from Biogen, Merck Serono, Novartis, Roche and Teva; has been member of advisory boards for Actelion, Biogen, Celgene, Merck Serono, Novartis and Sanofi Genzyme; and has been supported by the Czech Ministry of Education ñ project Cooperatio LF1, research area Neuroscience, and the project National Institute for Neurological Research (Programme EXCELES, ID project No LX22NPO5107) ñ funded by the European Union-Next Generation EU. SO has nothing to disclose. AL has received personal compensation for consulting, serving on a scientific advisory board, speaking or other activities from Alexion, Biogen, Bristol Myers Squibb, Horizon, Janssen, Merck Serono, Novartis and Sanofi/Genzyme, and her institutions have received research grants from Novartis and Sanofi/Genzyme. VT has received consultation and speaker fees, travel grants and research support from: Biogen, Sanofi Genzyme, Merck, Novartis, Roche, Alexion, Viatris, Janssen, Bristol Myers Squibb, Almirall. RA received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche and Sanofi-Genzyme. KB received speaker honoraria and/or education support from Biogen, Teva, Novartis, Genzyme-Sanofi, Roche, Merck and Alexion; has been a member of advisory boards for Merck and Biogen. OS received honoraria and consulting fees from Bayer Schering, Novartis, Merck, Biogen and Genzyme. CB received conference travel support from Biogen, Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis. RT has nothing to disclose. DM received speaker honoraria for Advisory Board and travel grants from Alexion, Almirall, Bayer, Biogen, Bristol Myers Squibb, Merck, Novartis, Roche, Sanofi-Genzyme and Teva. BY received honoraria as a speaker and member of scientific advisory boards from Sanofi, Bayer, Biogen, Merck, Janssen, Novartis, Roche and Aspen. SJK received compensation for scientific advisory board activity from Merck and Roche, and received compensation for serving on the IDMC for Biogen. DS received honoraria as a consultant on scientific advisory boards by Bayer-Schering, Novartis and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva and Merck. JL-S received travel compensation from Novartis, Biogen, Roche and Merck. Her institution receives the honoraria for talks and advisory board commitment as well as research grants from Biogen, Merck, Roche, TEVA and Novartis. MG has nothing to disclose. PD served on editorial boards and has been supported to attend meetings by EMD, Biogen, Novartis, Genzyme and TEVA Neuroscience. He holds grants from the CIHR and the MS Society of Canada and has received funding for investigator-initiated trials from Biogen, Novartis and Genzyme. AA-A received personal compensation for serving as a Scientific Advisory or speaker/moderator for Novartis, Biogen, Roche, Sanofi-Genzyme and Merck. RA received conference travel support from Novartis, Teva, Biogen, Bayer and Merck and has participated in clinical trials by Biogen, Novartis, Teva and Actelion. MF received travel and meeting attendance support from Novartis, Biogen, Roche, Sanofi-Genzyme and Merck. AS received travel and meeting attendance support from Novartis, Biogen, Roche, Merck, Bristol, Sanofi-Genzyme, Almirall, Piam. FP received personal compensation for serving on advisory board by Almirall, Alexion, Biogen, Bristol, Janssen, Merck, Novartis and Roche. He further received research grant by Alexion, Almirall, Biogen, Bristol, Merck, Novartis and Roche and by FISM, Reload Association (Onlus), Italian Health Minister and University of Catania. VVP received travel grants from Merck Healthcare KGaA (Darmstadt, Germany), Biogen, Sanofi, Bristol Meyer Squibb, Almirall and Roche. His institution has received research grants and consultancy fees from Roche, Biogen, Sanofi, Merck Healthcare KGaA (Darmstadt, Germany), Bristol Meyer Squibb, Janssen, Almirall, Novartis Pharma and Alexion. CR-T has received consulting fees, speaker honoraria, support for attending meetings and/or travel, participation on advisory board and research grants for her institution from Biogen, Novartis, Sanofi, Bristol, Roche, Almirall, Janssen, Sandoz and Merck. JLS-M accepted travel compensation from Novartis, Merck and Biogen, speaking honoraria from Biogen, Novartis, Sanofi, Merck, Almirall, Bayer and Teva and has participated in clinical trials by Biogen, Merck and Roche. AA received speaker honoraria from Novartis and Alexion. PG has served in advisory boards for Novartis, EMD Serono, Roche, Biogen idec, Sanofi Genzyme, Pendopharm and has received grant support from Genzyme and Roche, has received research grants for his institution from Biogen idec, Sanofi Genzyme and EMD Serono. EC has nothing to disclose. TC received speaker honoraria/ conference travel support from Biogen, Merck, Novartis, Roche, Sanofi-Aventis and Teva. GL received travel and/or consultancy compensation from Sanofi-Genzyme, Roche, Teva, Merck, Novartis, Celgene, Biogen. BW received honoraria for acting as a member of Scientific Advisory Boards/Consultancy for Alexion, Almirall, Biogen, Celgene/BMS, Merck, Janssen, Novartis, Roche, Sandoz and Sanofi-Genzyme; speaker honoraria and travel support from Biogen, Celgene/BMS, Merck, Novartis, Roche and Sanofi-Genzyme; and research and/or patient support grants from Biogen, Janssen, Merck, Sanofi-Genzyme and Roche. Honoraria and grants were paid to UZA/UZA Foundation. Further, she received research funding from FWO-TBM, Belgian Charcot Foundation, Start2Cure Foundation, Queen Elisabeth Medical Foundation for Neurosciences and the National MS Society USA. RM received remuneration for his speaking engagements, advisory board memberships, research and travel from Biogen, Merck, Genzyme, Bayer, Roche, Teva, Novartis, CSL, BMS, MedDay and NHMRC. IR served on scientific advisory boards/steering committees for Novartis and Merck; and received conference travel support and/or speaker honoraria from Roche, Novartis, Biogen, Teva, SanofiGenzyme and Merck.

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