First-line treatment options for managing relapsing forms of multiple sclerosis (MS) primarily involve disease-modifying therapies (DMTs) and management of acute relapses with corticosteroids.
For acute relapses, the recommended first-line treatment is oral methylprednisolone 0.5 g daily for 5 days, offered as early as possible and within 14 days of symptom onset. Intravenous methylprednisolone 1 g daily for 3 to 5 days is an alternative if oral steroids are not tolerated or have failed, or if hospital admission is required due to severity or comorbidities. Lower doses of steroids are not recommended, and patients should not be given steroids to self-administer for future relapses. The benefits and risks of steroid treatment should be discussed with the patient, including potential side effects such as temporary mental health effects and blood glucose worsening in diabetes NICE NG220,NICE CKS.
Regarding long-term management, disease-modifying treatments are the cornerstone for relapsing MS to reduce relapse frequency and delay progression. NICE technology appraisal guidance provides detailed recommendations on DMTs, which should be selected and monitored by specialist MS teams. The choice of DMT may be influenced by relapse frequency and severity NICE NG220.
Non-pharmacological management includes multidisciplinary care coordination, lifestyle advice such as encouraging regular exercise and smoking cessation, and addressing symptom management and rehabilitation needs NICE NG220,NICE CKS.