To follow is a list of some of the medications 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 and Drug Administration (FDA) specifically for the treatment of MS.
The corticosteroids listed below are approved by the FDA for the treatment of MS relapses. They may be given via intravenous (IV) infusion, intramuscular injection (IM), or orally (by mouth). However, each one typically has a preferred route of administration, which is noted where relevant.
- Solu-Medrol® (IV methylprednisolone)
- Decadron® (dexamethasone)
Details on Corticosteroids
Corticosteroids work by reducing inflammation in the central nervous system (CNS). While they usually lessen the severity and duration of a relapse, they may not affect the long-term progression of the disease.
When treatment is required, relapses are usually 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, introducing the drug directly into the bloodstream for a quicker response. Administration may be performed in a hospital, infusion center, or sometimes at home.
The corticosteroid Solu-Medrol (methylprednisolone) is frequently used to treat an MS relapse via IV infusion. In practice, doctors may sometimes prescribe the corticosteroid Decadron (dexamethasone) in place of methylprednisolone. Occasionally, but not often, an “oral taper” may be prescribed after a high-dose IV treatment to ease the patient off the treatment. Tapered over one-to-two weeks, oral forms of prednisone or Decadron are commonly used for this purpose.
As noted, Solu-Medrol or Decadron is usually given in large doses via IV infusion to initially treat an MS relapse. However, either of these corticosteroids may be given orally when IV infusions are not practical or appropriate for an individual. This enables patients to receive the high-dose treatment for a relapse without leaving their home or requiring a medical professional to administer an IV. However, many pills are required to equal the same dose as that given via IV. While still controversial, this method of administration has been gaining support among some MS experts.
Additional Treatment Options Overview
Of the following three additional treatment options, only the first one – ACTH – is approved by the FDA specifically for the treatment of MS relapses. The latter two have not been FDA-approved specifically for MS relapses. Clinical trials have yielded mixed results.
- Acthar® Gel (ACTH) – injected either into the muscle (intramuscularly) or under the skin (subcutaneously)
- Plasmapheresis (plasma exchange or PE)
- Intravenous immunoglobulin (IVIG) therapy
Details on Additional Treatment Options
ACTH (brand name, 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 ACTH is similar to corticosteroids.
ACTH contains a highly purified form of the hormone adrenocorticotropin 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. ACTH works differently than corticosteroids by helping the body to produce its own natural steroid hormones that reduce inflammation and aid in recovery.
Experimental therapies include plasmapheresis (also know as 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 effectiveness in the treatment of MS relapses.