***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: THE PURPOSE of this report is to present the results of a double-blind drug trial in which an oral corticosteroid , methylprednisolone ( Medrol ) , was compared to oral cyanocobalamin ( vitamin B12 ) in patients with multiple sclerosis . This pair of drugs was chosen for comparison for several reasons . If multiple sclerosis is a peculiar auto-immune disease related to the myelin of the brain , then it might be reasonable to expect that corticosteroids may favorably alter the course of the disease.1A number of reports in the recent literature have dealt with clinical trials of corticosteroids and corticotropin ( ACTH ) in the treatment of patients with multiple sclerosis .  Studies by Alex and er et al on corticotropin,2,3which did not include modern statistical design s such as r and omization of administration of placebo and corticotropin and a double-blind technique , have indicated a favorable response . Miller et al,4utilizing a modern statistical design , also concluded that The immunological effects of high‐dose methylprednisolone in attacks of multiple sclerosis and acute optic neuritis have only been examined in a few r and omized , controlled trials . We studied immunological changes in 50 patients with optic neuritis or multiple sclerosis who underwent lumbar puncture before and 1 week after completing a 15‐day course of oral high‐dose methylprednisolone treatment .  Treatment result ed in a decrease in the concentration of myelin basic protein , a decrease in the serum concentration of immunoglobulin G ( IgG ) and intrathecal IgG synthesis , an increase in the cerebrospinal fluid concentration of transforming growth factor‐β1 , and changes in the expression of CD25 , CD26 , and human leukocyte antigen‐DR ( HLA‐DR ) on CD4 T‐cells . No effect was seen on the cerebrospinal fluid leucocyte count or the cerebrospinal fluid activity of matrix metalloproteinase‐9 ( MMP‐9 ) . The lack of a persistent effect on cerebrospinal fluid leucocyte recruitment and MMP‐9 activity , despite changes in IgG synthesis , T‐cell activation , and cytokine production , suggests that modulation of the function of inflammatory cells may contribute to the clinical efficacy of oral high‐dose methylprednisolone treatment in optic neuritis and multiple sclerosis 30 patients with acute exacerbations of multiple sclerosis were treated by ACTH , dexamethasone or methylprednisolone in a double-blind r and omized study . Clinical parameters were assessed ; cerebrospinal fluid and neurophysiological parameters ( visual- and brainstem-evoked potentials ) were evaluated at the beginning and at the end of treatment . Dexamethasone was more effective than ACTH and 6-methylprednisolone in shortening bout duration . Neither CSF nor neurophysiological parameters were significantly affected by therapy The efficacy of dexamethasone ( DX ) and methylprednisolone ( MP ) at high ( HD ) and low ( LD ) dose in acute multiple sclerosis ( MS ) relapses was evaluated by a double-blind trial in 31 patients followed for 1 year .  DX and HDMP were similarly efficacious in promoting recovery , while LDMP was ineffective in the short-term outcome and was followed by an early clinical reactivation . The different outcomes seem to be related to different immunomodulating effects , mainly on cerebrospinal fluid ( CSF ) IgG synthesis and on peripheral blood and CSF CD4 + lymphocyte subsets We investigated the effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in patients with multiple sclerosis . Following a double blind trial design ed to compare the effect of oral and intravenous methylprednisolone treatment on promoting recovery from acute relapses of multiple sclerosis , 80 patients were followed for two years with six-monthly assessment s during which all subsequent relapses were recorded . The annual relapse rate was slightly higher in the oral compared with the intravenous methylprednisolone-treated patients ( 1.06 vs. 0.78 ) , but the adjusted difference between the two groups was not statistically significant ( 0.18 ; 95 % CI -0.19 to 0.55 , P=0.3 ) . The time to onset and the severity of the first relapse after treatment , the number of relapse free patients at the end of the follow-up period , and the severity of the relapses during the follow-up period were similar in the two groups . This trial did not show a statistically significant difference in relapse rate during the first two years following oral compared with intravenous methylprednisolone treatment Objective : To assess the efficacy of oral high-dose methylprednisolone in acute optic neuritis ( ON ) . Background : It has been determined that oral high-dose methylprednisolone is efficacious in attacks of MS . Methods : A total of 60 patients with symptoms and signs of ON with a duration of less than 4 weeks and a visual acuity of 0.7 or less were r and omized to treatment with  placebo ( n = 30 ) or oral methylprednisolone ( n = 30 ; 500 mg daily for 5 days , with a 10-day tapering period ) . Visual function was measured and symptoms were scored on a visual analog scale ( VAS ) before treatment and after 1 , 3 , and 8 weeks . Primary efficacy measures were spatial vision and VAS scores the first 3 weeks ( analysis of variance with baseline values as the covariate ) , and changes in spatial vision and VAS scores after 8 weeks . A significance level of p < 0.0125 was employed . Results : The VAS score ( p = 0.008 ) but not the spatial visual function ( p = 0.03 ) differed in methylprednisolone- and placebo-treated patients during the first 3 weeks . After 8 weeks the improvement in VAS scores ( p = 0.8 ) and spatial visual function ( p = 0.5 ) was comparable with methylprednisolone- and placebo-treated patients . A post hoc subgroup analysis suggested that patients with more severe baseline visual deficit and patients treated early after onset of symptoms had a more pronounced response to treatment . The risk of a new demyelinating attack within 1 year was unaffected by treatment . No serious adverse events were seen . Conclusion : Oral high-dose methylprednisolone treatment improves recovery from ON at 1 and 3 weeks , but no effect could be demonstrated at 8 weeks or on subsequent attack frequency Objective : There is only limited evidence from adequately controlled clinical trials to support high-dose methylprednisolone therapy for attacks of multiple sclerosis ( MS ) and none supporting oral administration . We assessed the effect of oral high-dose methylprednisolone therapy in attacks of MS . Methods : Twenty-five patients with an attack of MS lasting less than 4 weeks were r and omized to placebo treatment . Twenty-six patients received oral methylprednisolone ( 500 mg once a day for 5 days with a 10-day tapering period ) . The patients received scores on the Scripps Neurological Rating Scale ( NRS ) and Kurtzke Exp and ed Disability Status Scale . The symptoms were scored on a visual analog scale ( VAS ) before treatment and after 1 , 3 , and 8 weeks of treatment . Primary efficacy measures were NRS and VAS scores in the first 3 weeks and changes in NRS score and answers to an efficacy question naire administered after 8 weeks of treatment . Results : Changes in NRS scores among methylprednisolone- and placebo-treated patients differed significantly in the first 3 weeks and after 8 weeks(p = 0.005 and p = 0.0007 ) . VAS scores the first 3 weeks and treatment efficacy after 8 weeks also favored a beneficial effect of methylprednisolone treatment ( p = 0.02 and p = 0.05 ) . After 1 , 3 , and 8 weeks , 4 % , 24 % , and 32 % in the placebo group and 31 % , 54 % , and 65 % in the methylprednisolone group had improved one point on the Exp and ed Disability Status Scale score ( all p < 0.05 ) . No serious adverse events were seen . Conclusion : Oral high-dose methylprednisolone is recommended for managing attacks of MS To compare the efficacy of high-dose intravenous methylprednisolone with intramuscular ACTH in the treatment of acute relapse in multiple sclerosis , we undertook a double-blind , r and omized , controlled study involving 61 patients . There was a marked improvement in both groups in the course of the study , but no difference between them in either the rate of recovery or the final outcome . High-dose IV methylprednisolone is a safe alternative to ACTH in the management of acute relapse in MS Oral prednisone 1might be a convenient , inexpensive alternative to IV methylprednisolone ( IVMP ) if the bioequivalent dose was known . We compared the total amount of steroid absorbed after 1250 mg oral prednisone vs 1 gram IVMP in 16 patients with multiple sclerosis ( MS ) . At 24 hours , the mean area under the concentration-time curve ( AUC ) , the main component of bioavailability , did not differ between groups ( p = 0.122 ) . This suggests that the amount of absorbed corticosteroid is similar after either steroid at these doses BACKGROUND An intravenous rather than oral course of methylprednisolone is often prescribed for treating acute relapses in multiple sclerosis ( MS ) despite the lack of evidence to support this route of administration . Our double-blind placebo-controlled r and omised trial was design ed to compare the efficacy of commonly used intravenous and oral steroid regimens in promoting recovery from acute relapses in MS . METHODS 42 patients with clinical ly definite relapse in MS received oral , and 38 intravenous , methylprednisolone . Clinical measurements at entry and at 1 week , 4 weeks , 12 weeks , and 24 weeks included Kurtzke 's exp and ed disability status scale ( EDSS ) , Hauser 's Ambulatory Index , and an arm-function index . The primary outcome criterion was a difference between the two treatment groups of one or more EDSS grade s at 4 weeks . FINDINGS There were no significant differences between the two groups at any stage of the study in any measurement taken : the mean difference in EDSS at 4 weeks ( adjusted for baseline level ) was 0.07 grade s more in those taking oral steroids ( 95 % CI -0.46 to 0.60 ) . The most optimistic outcome for intravenous therapy is an average benefit of less than half a grade improvement on EDSS over oral treatment . INTERPRETATION Since our study did not show any clear advantage of the intravenous regime we conclude that it is preferable to prescribe oral rather than intravenous steroids for acute relapses in MS for reasons of patient convenience , safety , and cost Many patients with multiple sclerosis ( MS ) are currently receiving treatment with interferon (IFN)–β . Early identification of nonresponder patients is crucial to try different therapeutic approaches . We investigated various criteria of treatment response to assess which criterion better identifies patients with a poor response We investigated in multiple sclerosis the difference between two commonly used oral and intravenous steroid regimens on the level of adhesion molecule expression on blood T lymphocytes , the distribution of circulating T cell subsets , and the concentration of serum tumour necrosis factor alpha . Venous blood sample s were collected from a cohort of 22 patients with acute relapses who were participating in a r and omised trial comparing intravenous methylprednisolone 1000 mg daily for 3 days with oral methylprednisolone 48 mg daily for one week , 24 mg daily for one week , and finally 12 mg daily for one week . There was a similar significant reduction of T cell LFA-1 surface expression and serum TNF alpha concentrations after 4 days of treatment with each regimen . There was no change in other lymphocyte adhesion molecules expression ( ICAM-1 , LFA-3 or CD2 ) at day 4 , although LFA-3 and CD2 expression was moderately decreased at day 28 and day 90 respectively ; nor was there any change in the distribution of lymphocyte subsets ( CD4 , CD8 , and CD45RA , CD45RO ) , although a small decrease in CD45RO circulatory T cells was noted at day 28 . This study suggests that some of the beneficial effects of glucocorticosteroids may be related to the inhibition of lymphocyte adhesion as well as the modulation of proinflammatory cytokines The objective of this study was to investigate the feasibility of treating relapses of multiple sclerosis ( MS ) at home with oral dexamethasone .  Twenty-five out of 28 consecutive patients with MS who presented with a relapse of less than 2 weeks ' duration were treated on an open basis with oral dexamethasone 16 mg per day ( four divided doses ) for 5 consecutive days . After one week , the exp and ed disability status scale ( EDSS ) had improved by one or more grade s in 88 % ( 22 patients ) and after 4 weeks in 92 % ( 23 patients ) . Treatment was well tolerated . We conclude that a course of oral dexamethasone 16 mg per day shortens the duration of an exacerbation in MS in a similar way as seen after high dose i.v . methylprednisolone . Although a r and omized study is needed to test this treatment regimen against i.v . high do 
    Output:
    
The analysis of the five included trials comparing intravenous versus oral steroid therapy for MS  relapses do not demonstrate any significant differences in clinical ( benefits and adverse events ) , radiological or pharmacological outcomes .
Based on the evidence , oral steroid therapy may be a practical and effective alternative to intravenous steroid therapy in the treatment of MS relapses