A new study has revealed that individuals with multiple sclerosis (MS) who are on pulsed methylprednisolone therapy might be at greater risk of liver injury.

The study, published in Multiple Sclerosis and Related Disorders, also found that patients with liver injury were more likely to have a history of alcohol abuse, nonalcoholic fatty liver disease (NAFLD), and hyperlipidemia than those without liver injury.

“Treatment with short-term (pulsed) high-dose intravenous methylprednisolone is associated with a variety of adverse effects, including, but not limited to, hyperglycemia, tachycardia, flushing, gastrointestinal symptoms, sleep disturbance, psychotic responses, neutrophilia, and lymphopenia,” the authors wrote. “More importantly, treatment with high-dose methylprednisolone has been linked to hepatic injury.”

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The research team prospectively assessed 314 adult patients with MS at a single center who were treated with pulsed methylprednisolone therapy for relapses between May 2020 and May 2021. After 5 days of the therapy, patients were given tapering oral prednisolone for 10 to 15 days. Biochemical liver function tests were performed before the treatment and 1 week and 1 month post-treatment.

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The investigation revealed that 9 patients (2.86%) had liver injury after the treatment, with no severe cases. The increased liver enzyme levels found after treatment subsided during follow-up. Patients with liver injury were significantly more likely to have NAFLD, hyperlipidemia, and a history of alcohol abuse than those without liver injury.

The authors recommend close monitoring of liver function and careful follow-up of patients with MS undergoing pulsed methylprednisolone therapy, particularly in those with any of the risk factors mentioned.


Namaei P, Ghadiri F, Jamali R, Azimi AR, Shabestari HRF, Vahabizad F. Evaluation of liver injury in multiple sclerosis patients receiving pulsed steroid therapy. Mult Scler Relat Disord. Published online June 16, 2022. doi:10.1016/j.msard.2022.103968