Understanding MS Relapse

Multiple sclerosis (MS) is a chronic, or long-term, condition. It has acute, or short and severe, stages called relapses. Some people call these flares, exacerbations, or attacks. MS relapses are indications of active disease. Just like MS itself, MS relapses are different for different people—and each relapse you have may be different too. You might find walking difficult or have problems with your vision. Others might have numbness in their limbs.

MS damages the protective covering around the nerve cells, and ultimately the nerve cells in your brain, optic nerves, or spinal cord. MS relapses are unpredictable, yet common, signs of the inflammation that causes that damage.

Most likely, your doctor has prescribed a disease-modifying therapy (DMT) as an important, central part of your MS treatment. The use of DMTs may reduce the rate of MS relapses—the number you might experience over time. DMTs may not treat or totally prevent relapses, and the relapses themselves should be identified and treated rapidly.

How to Tell if You're Having a Real Relapse

It can sometimes be challenging to tell whether you’re having symptoms of MS attack or whether you’re just not feeling well due to other causes. Yet it’s important to get treatment for a relapse as soon as possible once it starts.


You have new MS symptoms or your existing MS symptoms suddenly become worse

These symptoms last for at least 24 hours (they may go on for days or weeks)

Your symptoms occur at least 30 days after your last relapse

You don’t have a fever, illness, or similar condition when the symptoms start

Download the Symptom Journal or the My MS Manager™ app from the Multiple Sclerosis Association of America to help you keep track of your symptoms regularly and identify relapses early.

Multiple Sclerosis Relapse and Acthar

Make A Plan To Treat MS Relapse

Whether you are currently experiencing a relapse or you’re monitoring the progression of your MS, make a plan with your doctor to recognize and treat your MS relapse symptoms. The goals of treating an MS relapse are to reduce inflammation, speed recovery, and minimize disability.

Just like with your ongoing MS treatment, it may take a few tries to find the relapse treatment that works for you. As you and your doctor make your treatment plan, it’s important to also plan check-ins to monitor your progress toward your treatment goals. Tell your doctor if your treatment is not working, difficult to tolerate, or inconvenient to administer. You may want to investigate an alternate treatment option or connect at a live event near you with other people who have relapsing MS.

Hear From Yosafa—Diagnosed With MS in 2003

Who should NOT take Acthar?

You should not take Acthar if you have:

  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye problems, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of ulcers
  • Heart problems
  • High blood pressure that is not controlled
  • Allergies to pig-derived proteins
  • Been recently given a vaccine or are about to take one
  • Suspected congenital infections (in children under 2 years of age)
  • A condition where your adrenal glands produce either too much of certain hormones (as with Cushing’s syndrome), or not enough (adrenal insufficiency)

Tell your doctor if you have any of these conditions or any other health problems. Also, share with your doctor what medicines you are taking. Don’t forget to mention nonprescription medicines, vitamins, and herbal supplements.

What is the most important information I should know about Acthar?

  • Never inject Acthar directly into a vein, and always take Acthar as prescribed by your doctor
  • Never stop treatment suddenly unless your doctor tells you to
  • Try not to miss any scheduled doctor’s appointments, as it is important for the doctor to monitor you while taking Acthar

Acthar can cause side effects similar to those with steroid treatments. While taking Acthar, tell your doctor right away if you have any of the symptoms listed here:

  • Increased risk of infections. You may be more likely to get new infections. Also, old infections may become active. Before and during treatment, tell your doctor if you see any signs of an infection. Contact your doctor at the first sign of an infection or fever. Signs of infection are fever, cough, vomiting, or diarrhea. Other signs may be flu or any open cuts or sores
  • Adrenal gland changes. When taking Acthar long term, your adrenal gland may produce too much of a hormone called cortisol, which may cause symptoms of Cushing’s syndrome, such as upper body fat, rounded “moon” face, bruising easily, or muscle weakness. Sometimes when you stop taking Acthar long term, your body may not produce enough cortisol on its own. This is called “adrenal insufficiency.” Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • Increased blood pressure, body salt, and fluid levels. Your doctor may check your blood pressure while you are being treated with Acthar. He or she may recommend some changes to your diet, such as eating less salt and taking certain supplements
  • Unpredictable response to vaccines. Talk to your doctor about which vaccines are safe to use when you are taking Acthar
  • Masking other conditions. Acthar may hide symptoms of other diseases. This can make it more difficult for your doctor to make a diagnosis if something else is going on
  • Stomach or intestinal problems. Acthar may put you at increased risk for bleeding from the stomach or getting stomach ulcers. Tell your doctor if you have stomach pains, bloody vomit, bloody or black stools, excessive tiredness, increased thirst, difficulty breathing, or increased heart rate
  • Changes in mood or behavior. Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping
  • Worsening of other medical conditions. If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • Eye problems. It’s possible that you may develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Allergic reactions. Your body may develop antibodies or become sensitive when Acthar is used long term. Signs of allergic reaction in children are:
    • Skin rash
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • Problems with growth and physical development. Using Acthar long term can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Bone density loss. Acthar may cause osteoporosis at any age
  • Potential harm to unborn baby. Tell your doctor if you are pregnant or plan on becoming pregnant

What are the most common side effects of Acthar?

The most common side effects of Acthar are similar to those of steroids. They include:

  • Fluid retention
  • Changes in blood sugar
  • Increased blood pressure
  • Behavior and mood changes
  • Changes in appetite and weight

Specific side effects in children under 2 years of age include:

  • Increased risk of infections
  • Increased blood pressure
  • Irritability
  • Symptoms of Cushing’s syndrome
  • Cardiac hypertrophy (thickening of the heart muscle)
  • Weight gain

The above side effects may also be seen in adults and children over 2 years of age.

These are not all of the possible side effects of Acthar.

Tell your doctor about any side effect that bothers you, or that does not go away. Call your doctor or pharmacist for medical advice about side effects. You may report side effects to the FDA. Call 1-800-FDA-1088 or visit www.fda.gov/medwatch. You may also report side effects by calling 1-800-778-7898.

Please see full Prescribing Information.

H.P. Acthar® Gel (repository corticotropin injection) [H P AK-thar jel]

What is H.P. Acthar Gel?

H.P. Acthar® Gel (repository corticotropin injection) is used for:

  • Treatment for flares or on a regular basis (maintenance) in people with systemic lupus erythematosus (lupus)
  • Treatment of infantile spasms in infants and children under 2 years of age
  • Treatment for adults with acute relapses or flares of multiple sclerosis (MS). Studies have shown H.P. Acthar Gel to be effective in speeding recovery from an MS relapse. However, there is no evidence that Acthar affects the ultimate outcome or natural history of the disease
  • The reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that is due to lupus erythematosus (lupus)
  • Treatment for flares or on a regular basis (maintenance) in people with dermatomyositis or polymyositis (DM-PM)
  • Treatment for people with symptoms of sarcoidosis
  • Short-term add-on therapy in the event of symptoms suddenly worsening (flare) for psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis (in some cases, may require low-dose maintenance therapy), and ankylosing spondylitis (fusion of the spinal vertebrae)
  • Treatment of severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina
  • Short-term add-on therapy in the event of symptoms suddenly worsening (flare) for psoriatic arthritis
  • Add-on treatment for recurring symptoms, or on a regular basis, in people with rheumatoid arthritis (RA)
  • Acthar is injected beneath the skin or into the muscle.

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