Brief Course of Ultra-High Dose IV Methylprednisolone in the Treatment of Multiple Sclerosis Exacerbations

Despite the introduction of a number of effective disease modifying therapies (DMT) for multiple sclerosis (MS) over the past 25 years, a need remains for an effective method of treating breakthrough relapses, which impact disease progression. ACTH and corticosteroids have fulfilled this role for the past 50 years. However, based upon our current understanding of the cadence of an exacerbation, and its importance in the progression of MS, an alternative is proposed. This utilizes a very brief course of an ultra-high dose of intravenous methylprednisolone, adapted from the megadose protocol of methylprednisolone in acute spinal cord injury. Despite the known side effect profile of corticosteroids, and the ultra-high dose employed, the brevity in administration yields a well-tolerated, rapid resolution of the relapse