Table 1.

Expert statements from US MS Organizations on MS relapse treatments

Treatment	Approveda	National Multiple Sclerosis Society14,15	American Academy of Neurology7,16
IVMP	Yes	CS are the accepted standard of care. The steroid most often used is IVMP.	CS have been demonstrated to have a short-term benefit on the speed of functional recovery in patients with acute attacks of MS.
RCI	Yes	RCI is shown to be as effective as IVMP and may have a place in situations where IV infusion is impractical or positive effects on bone via stimulation of dehydroepiandrosterone and mineralocorticoids may be desirable.	Not mentioned
PMP	Not reviewed	Second-line treatment for steroid-resistant exacerbations.	May be helpful in the treatment of severe acute episodes of demyelination in previously nondisabled individuals.
IVIG	Nob	IVIG may be considered for relapses during pregnancy (during which time steroids should be avoided if possible, except in severe cases where required) IVIG is also sometimes used to treat relapses that do not respond to CS, although the supportive evidence is limited.	There are insufficient data to support the use of IVIG as monotherapy for MS relapses.

Notes: ^aApproved and indicated for use by the US FDA; procedures such as plasmapheresis are not reviewed by FDA. ^bReviewed by the FDA but not approved for treatment of MS relapse.

Abbreviations: CS, corticosteroids; FDA, US Food and Drug Administration; IVIG, intravenous immunoglobulin; IVMP, intravenous methylprednisolone; MS, multiple sclerosis; N/A, not applicable; PMP, plasmapheresis; RCI, repository corticotropin injection; US, United States.