Less-severe relapses are usually not treated with steroids, so their use may be reserved for more severe flare-ups. When treatment is required, relapses are often treated with a high-dose course of powerful corticosteroids (a type of steroid) over a period of three to five days. These are given by intravenous (IV) infusion, providing the drug directly into the bloodstream for a quicker response. Administration may be performed in a hospital, infusion center, or sometimes at home. Corticosteroids work by reducing inflammation in the CNS. While they usually lessen the severity and duration of a relapse, they do not appear to affect the long-term progression of the disease.
As approved by the United States Food and Drug Administration (FDA), patients are often given the corticosteroid methylprednisolone (Solu-Medrol®) to treat an MS relapse. In practice, doctors may sometimes prescribe the corticosteroid dexamethasone (Decadron®), in place of methylprednisolone. The oral steroid prednisone may be prescribed after a high-dose IV treatment to ease the patient off the treatment, tapered over one to two weeks.
Both methylprednisolone and dexamethasone are also available in pill form. To avoid the inconvenience of IV treatments, some neurologists are now prescribing very large doses of either corticosteroid to be taken orally. This enables their patients to receive the high-dose treatment for a relapse without leaving their home or requiring a medical professional to administer an IV. While still controversial, this method of administration has been gaining support among some MS experts.
Acthar® Gel is also approved by the FDA to treat MS relapses and has been used as an alternative to corticosteroids for more than 30 years. This may be helpful for individuals who are not able to tolerate the side effects of steroids, who have found that previous treatments were not effective, or who may have difficulty getting timely medical support for IV infusions. Studies suggest that the effectiveness of Acthar Gel is similar to corticosteroids.
Acthar contains a highly purified form of the hormone adrenocorticotropin (ACTH) in gelatin. It is given once daily for two to three weeks and is injected either into the muscle or under the skin. The ACTH is then absorbed slowly into the bloodstream. Acthar works differently than corticosteroids by helping the body to produce its own natural steroid hormones that reduce inflammation and aid in recovery. For more information, please visit acthar.com/acthar-patient-support or call (877) 503-7746.
Similar to Acthar Gel, Purified Cortrophin™ Gel (Repository Corticotropin Injection USP) is also a purified preparation of the hormone adrenocorticotropin (ACTH) in gelatin. The commercial launch of this second ACTH product was announced in January 2022. This medication is indicated for the treatment of acute relapses in multiple sclerosis (MS), as well as certain other chronic autoimmune disorders, such as rheumatoid arthritis (RA).
Cortrophin Gel is now available by prescription through a network of specialty pharmacies and distributors, providing a second treatment option for individuals who do not tolerate or derive benefit from IV steroids. The makers of Cortrophin Gel have created “Cortrophin In Your Corner,” a support program for patients and their carepartners, as well as healthcare professionals and their staff. For more information, please visit cortrophin.com or call (800) 805-5258.
Other therapies include plasmapheresis (plasma exchange or “PE”) and intravenous immunoglobulin (IVIG). Neither of these is approved by the FDA specifically for MS relapses, but either therapy may occasionally be used for individuals who are experiencing a severe relapse and are not responding to other treatments. With PE, blood is taken from the patient, cleansed of potentially toxic elements, and returned to the patient. IVIG therapy uses human immunoglobulin, an antibody derived from the blood of healthy donors. With both of these therapies, more studies are needed to determine their individual effectiveness.
To follow is a list of drugs and therapies that may be used in the treatment of an MS relapse. Not all of these treatments are approved by the United States Food & Drug Administration (FDA) specifically for the treatment of MS.
- Solu-Medrol® (IV methylprednisolone)
- Decadron® (dexamethasone)
- Acthar® Gel
- Purified Cortrophin™ Gel
- Plasmapheresis (plasma exchange or PE)*
- Intravenous immunoglobulin (IVIG) therapy*
*Please note that with these latter two therapies, clinical trial results have been mixed. Studies continue to determine the effectiveness of these treatments with MS.