Solu-Medrol vs Acthar Gel for MS Relapses

Here is My Question:
Is there an opinion on using Solu-Medrol IV Drip versus Acthar Gel during a relapse?

Assuming Solu-Medrol is typically administered for 3-5 days during a relapse, would it ever be recommended to take a monthly or bi-monthly dose to help slow down frequent issues or relapses?

Answer:
Solu-Medrol is a synthetic corticosteroid that is similar to cortisol, while Acthar gel is essentially adrenocorticotropic hormone (ACTH) which stimulates an individual's adrenal glands to produce cortisol and other steroids.  Both have been effective in treating moderate to severe MS relapses.  General consensus seems to favor Solu-Medrol, although Acthar gel may be used in individuals who haven't responded to or have experienced too many side effects to Solu-Medrol.  Acthar gel is administered as an injection into the muscle, so for individuals who have very difficult veins, this is an alternative option.
 
Use of Solu-Medrol may provide biological benefit out to 6 months, however, clinical trial data have consistently demonstrated that synthetic steroid does not alter the ultimate course of MS.  Rather, steroids can speed up recovery from a relapse.  Pulsed steroids (monthy, bimonthly, quarterly, etc.) have been combined with disease modifying therapies (ie, interferon beta-1a) but showed no advantage to adding this to DMT.  The overarching principle to take away is that steroids do not actually alter the disease course of MS (however, the disease modifying therapies do), have significant side effects if taken chronically, and have a place in MS treatment for moderate to severe MS relapses.

A. Scott Nielsen MD
Virginia Mason MS Center