Steroids

Steroids, also called glucocorticoids or corticosteroids, are drugs made to mimic cortisol, a hormone produced by the adrenal glands in the body. Cortisol is a strong anti-inflammatory hormone that does many things in the body.^1,2

Steroids are mainly used to manage acute (short-term, rapid) attacks of neuromyelitis optica spectrum disorder (NMOSD). However, some people with NMOSD may require longer-term, low-dose steroids for good disease control.³

How do steroids work for NMOSD?

Steroids (corticosteroids) are strong anti-inflammatory drugs. When given in doses higher in amount than your body normally makes, steroids quickly decrease inflammation.^3,4

In NMOSD, high-dose steroids are vital to help limit vision loss during an attack of inflammation of the nerve fibers in the eye (optic neuritis). High-dose steroids also help to limit permanent damage to the spinal cord during an NMOSD attack resulting from inflammation of the spinal cord (transverse myelitis).⁵

NMOSD attacks involve nerve damage caused by inflammation in the central nervous system (CNS). The goal of steroid treatment is to control that inflammation and minimize damage.^5,6

Examples

There are many different types of steroids available. The most common steroid used for NMOSD during acute attacks is intravenous (IV) Solu-Medrol® (methylprednisolone sodium succinate). Oral (swallowed pill) steroids may be prescribed after IV therapy. Prednisone and prednisolone are the most common oral steroids used.^3,7,8

What are the possible side effects?

Steroids are strong drugs that can be effective in decreasing inflammation in NMOSD. However, the benefits of taking steroids must be weighed against the many possible side effects known to result from long-term use, especially at high doses.⁴

Short-term side effects of steroids may include:⁴

• High blood pressure
• Mental effects like mood swings, behavior changes, confusion
• Nausea
• High blood sugar, which can cause or worsen diabetes

Side effects of long-term steroid use may include:⁴

• Increased risk of infections
• Fluid retention
• Stomach ulcers
• Round appearance to the face (moon face)
• Weakening of bones (osteoporosis), which increases the risk of fractures
• Weight gain
• Increased pressure in the eye (glaucoma)
• Decreased adrenal gland hormone, which can lead to severe tiredness (fatigue), muscle weakness, and loss of appetite

These are not all the possible side effects of steroids. Talk to your doctor about what to expect when taking steroids. You should also call your doctor if you have any changes that concern you when taking steroids.

Other things to know

It is difficult to predict how fast or how completely steroids will work for each person. Steroids may or may not be effective for you.

It is common for doctors to prescribe high-dose IV Solu-Medrol for an acute (rapid onset of symptoms) attack of NMOSD. The most common symptoms treated with high-dose steroids are optic neuritis and transverse myelitis.³

IV therapy usually lasts for 5 days. The decision to continue steroids or add a new treatment is based on your symptoms and MRI findings at the end of 5 days of steroids. Steroids may be continued in pill form for a period of time after IV therapy.³

Your doctor may prescribe other drugs to help reduce the chances of stomach ulcers, infections, and osteoporosis while you are taking steroids, especially if taking long-term steroids.

Steroids are used in NMOSD to speed improvement of symptoms from an attack. Given their long-term side effects, high-dose steroids are not an ideal long-term therapy to prevent further attacks of the disease. Because of this, your doctor will prescribe other drugs and treatments to help prevent attacks and further nerve damage. Low-dose steroids may be needed for long-term therapy. Talk to your doctor about your treatment plan, as well as the risks and benefits of all drugs.^3,6

Before beginning treatment for NMOSD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.