When do you prescribe a steroid taper after the high dose IV course for a multiple sclerosis exacerbation?

Most of the available literature is sparse and largely anecdotal. I am not sure there are any class I data available out there that specify if an oral taper is needed vs. it is not. Given such minimal evidence for one over the other, I do not use an oral taper. The 1988 (phew, 34 years ago) ONTT tri...

Based on personal preference/experience, more often than not, I do follow a cycle of IV steroids with a short 12-day taper of oral prednisone. Every time the deficit is significant, disabling at presentation, I do a full 5 days of Solu-Medrol IV followed by the 12-day oral taper.

I don't do a taper if a patient has been treated with high-dose sterorids for 3-5 days, the risk of withdrawal is too low for such a short treatment period.