Study designs of evaluations included in the review
Randomised controlled trials were included in the review. Both blinded and unblinded trials were eligible.
Specific interventions included in the review
Steroids or adrenocorticosteroid hormone (ACTH). Studies that compared these with any type of control treatment were eligible for inclusion, but trials that compared different doses or modalities of steroid therapy were not considered. The actual therapies in the included studies were prednisone (15 to 70 mg orally, for 14 days to 18 months), methylprednisolone (8 to 1,000 mg orally or intravenously, for 5 days to 18 months) and ACTH (15 to 120 IU intramuscularly or subcutaneously, for 14 days to 18 months).
Participants included in the review
Patients with multiple sclerosis or optic neuritis. Of the studies included in the review, 7 were of mixed multiple sclerosis, 4 were of optic neuritis, 3 were of acute relapses and one was of chronic progression.
Outcomes assessed in the review
The outcome measures that were evaluated were:
lack of improvement by at least one point on the Expanded Disability Status Scale (EDSS) or on the Alexander scale; and
new relapse, defined as the appearance of one or more symptoms that persisted for more than 24 hours, or clinical worsening after a complete remission at the end of the follow-up.
In patients with optic neuritis, complete recovery of visual acuity was considered as a disability improvement of one point on the EDSS, and the occurrence of definite multiple sclerosis during the follow-up was considered equivalent to a new relapse.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.