How do you treat steroid-refractory MS flares when PLEX is unavailable?
I.e., lack of clinical improvement with steroids and/or continued accumulation of T2 enhancing lesions.
Has IVIG worked in your experience? Are there other options?
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What would be your next therapy for acute MS relapse without clinical relapse on IVMP if PLEX is not available?
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2 Answers
Mednet MemberInvited Expert
Neurology · Yale University School of Medicine
Answered on
There is limited evidence on the efficacy of IVIG for MS relapses. A repeat course of IV methylprednisolone within 2-3 weeks could be considered. If the patient is not already on high-efficacy DMT, then I would also promptly initiate anti-CD20 therapy.
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Mednet MemberInvited Expert
Neurology · Icahn School of Medicine at Mount Sinai
Answered on
IVIG is not effective. You could consider an additional course of high-dose IV methylprednisolone (or equivalently high oral steroids). There is a suggestion that ACTHAR gel (which I have almost never used) may work where IVMP has failed.
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