Implementing High Dose Oral Methylprednisolone for a Multiple Sclerosis Relapse in the Outpatient Setting

Abstract

Background

Intravenous methylprednisolone is the standard of care for a multiple sclerosis relapse. However, intravenous medications can create several barriers for patients and healthcare organizations. A non-inferiority study by Le Page et al. demonstrated no difference between a patient’s multiple sclerosis disability score when treated with high dose oral versus intravenous methylprednisolone. Implementing an oral methylprednisolone workflow for a multiple sclerosis relapse leads to healthcare cost savings and decreased healthcare utilization.

Methods

A neurology clinical pharmacist partnered with neurology providers to create and implement a standardized workflow for high dose oral methylprednisolone to treat multiple sclerosis relapses. From October 2018 – April 2022, patients were included in the retrospective analysis if they were prescribed oral methylprednisolone for a 3 or 5 day treatment course for the purpose of an multiple sclerosis relapse by a neurology provider from the same multiple sclerosis clinic. The primary outcome was evaluating healthcare utilization measured by infusion center chair time saved and direct health system cost savings.

Results:

Overall, 290 three-day oral methylprednisolone treatment courses and 50 five-day treatment courses were prescribed. This saved the infusion center 1,680 hours of medication administration time and contributed to an estimated $80,875 in health system cost savings.

Conclusion and Relevance:

Implementing a high dose oral methylprednisolone workflow for a multiple sclerosis relapse at an outpatient neurology clinic did help reduce health system cost and infusion center chair time.