Relapsing multiple sclerosis represents one of the most common forms of this chronic autoimmune disease, affecting hundreds of thousands of people across the United States. While there’s no cure, ongoing medical advances in both standard therapies and experimental clinical trial drugs offer growing hope for managing symptoms, reducing flare-ups, and maintaining quality of life for years to come.

How Modern Medicine Approaches Relapsing Multiple Sclerosis

When doctors diagnose someone with relapsing multiple sclerosis, the main treatment goals focus on several key areas. The first priority is reducing how often relapses occur and making them less severe when they do happen. Another important goal involves slowing down the progression of the disease itself, which means trying to prevent new damage to the brain and spinal cord over time. Equally important is managing the various symptoms that can appear during flare-ups or persist between them, helping people maintain their independence and continue their daily activities.^[1]

Treatment plans vary significantly from person to person because relapsing multiple sclerosis affects everyone differently. A therapy that works well for one patient might not be the best choice for another. Doctors consider many factors when creating a treatment plan, including the person’s age, overall health, how active their disease appears to be, whether they’re planning to have children, and what their lifestyle and work demands look like. The stage of the disease also matters greatly—starting treatment early often leads to better long-term outcomes.^[6]

Modern medicine offers two main categories of treatments. First are the established, approved therapies that medical societies and health authorities have recommended based on years of research and clinical use. These form the backbone of relapsing MS care today. Second are the innovative treatments currently being tested in clinical trials, which may represent the next generation of therapies. These experimental approaches are exploring completely new ways to address the underlying causes of multiple sclerosis.^[9]

Standard Treatment Approaches for Relapsing Multiple Sclerosis

The cornerstone of managing relapsing MS involves two distinct treatment strategies: managing acute relapses when they happen, and using long-term medications to modify the disease course itself. Understanding both types helps patients navigate their treatment journey more effectively.

Treating Acute Relapses

When someone experiences a relapse—meaning new symptoms appear or existing ones suddenly worsen and last more than 24 hours—doctors often prescribe high-dose corticosteroids to address the immediate flare-up. These powerful anti-inflammatory medications work by suppressing the immune system’s attack on the protective myelin coating around nerves in the brain and spinal cord. By reducing inflammation in the central nervous system, corticosteroids can shorten the duration of a relapse and help symptoms improve more quickly.^[8]

The most commonly used corticosteroid is methylprednisolone, often given by intravenous infusion (meaning the drug flows directly into the bloodstream through a vein). A typical treatment course involves receiving 1 gram per day for three to five consecutive days. This can be done in a hospital, an outpatient infusion center, or sometimes even at home with nursing support. Some patients receive an equivalent high-dose oral regimen instead, which involves taking about 1250 milligrams of prednisone by mouth. Research has shown that high-dose oral treatment can be equally effective as intravenous therapy while being more convenient and less expensive for patients.^[14]

After the high-dose treatment, doctors sometimes prescribe a tapering course of oral prednisone, gradually reducing the dose over one to two weeks. This helps ease the body off the medication rather than stopping abruptly. It’s important to note that while corticosteroids can dramatically improve symptoms during a relapse and help people recover faster, they don’t appear to change the long-term course of the disease or prevent future relapses. Their benefit is specifically for managing acute flare-ups.^[9]

Not every relapse requires steroid treatment. Doctors typically reserve these medications for moderate to severe relapses that significantly affect a person’s ability to function. Mild relapses that don’t greatly impact daily life might be monitored without aggressive treatment. This decision depends on which symptoms are present, how severe they are, and how much they interfere with important activities.^[8]

For patients who can’t tolerate corticosteroids due to side effects, or for those whose relapses don’t respond well to steroids, alternative treatments exist. Highly purified forms of adrenocorticotropin hormone, sold under brand names like Acthar Gel, act similarly to corticosteroids and are approved specifically for treating MS relapses. This medication is given once daily as an injection, usually into muscle tissue.^[8]

Disease-Modifying Therapies: The Foundation of Long-term Management

Disease-modifying therapies, often abbreviated as DMTs, represent the most important advance in multiple sclerosis treatment over the past three decades. The first DMT received approval in 1993, and since then, more than twenty different medications have become available. These drugs don’t cure MS or reverse damage that has already occurred, but they work by modifying how the disease behaves over time.^[10]

DMTs work through various mechanisms, but most act by modulating or suppressing parts of the immune system to prevent it from attacking the myelin sheath. By reducing immune system activity against the nervous system, these medications can significantly decrease the frequency and severity of relapses, slow the accumulation of new brain and spinal cord lesions visible on MRI scans, and potentially slow the progression of disability.^[6]

Different DMTs come in different forms. Some are taken by mouth as pills or capsules, which many patients find most convenient. Others are given as injections under the skin (subcutaneous) or into muscle (intramuscular), which patients can often learn to give themselves at home. Still others require intravenous infusion at a medical facility, typically every few weeks to every six months depending on the specific medication.^[7]

Among the most effective newer DMTs are medications that target B cells, a type of white blood cell that plays a key role in the immune system’s attack on myelin. Drugs like ocrelizumab (Ocrevus) and ofatumumab (Kesimpta) work by depleting circulating B cells in the bloodstream. Clinical studies have shown these medications to be remarkably effective, with some research indicating they can prevent relapses in approximately 98 percent of patients when used early in the disease course. These therapies are thought to slow disease progression and reduce the development of new brain lesions detected on MRI scans.^[6]

Other commonly prescribed DMTs include various forms of interferon beta, injectable medications that help regulate immune system function. Brand names include Avonex, Plegridy, and others. These have been used successfully for many years and have a well-established safety profile. Glatiramer acetate (Copaxone) is another injectable option that has been available for decades and works by modifying immune responses in a way that protects myelin.^[3]

Oral DMTs offer convenience for many patients. These include medications like dimethyl fumarate, teriflunomide, fingolimod, and others. Each works through different mechanisms but shares the goal of reducing disease activity. The choice among oral medications depends on factors like side effect profiles, how often the medication needs to be taken, and individual patient characteristics.^[10]

Starting a DMT as soon as possible after diagnosis is generally recommended. Research has consistently shown that earlier treatment leads to better long-term outcomes, with less disability accumulation over the years. The window of opportunity appears most important in the early stages of the disease, when active inflammation is causing the most damage. Starting effective treatment during this period can preserve more nervous system function and potentially prevent the transition to more progressive forms of MS.^[6]

Like all medications, DMTs can cause side effects. These vary depending on which medication is used. Injectable therapies often cause reactions at the injection site, such as redness, pain, or hardness of the skin. Interferon medications can cause flu-like symptoms, especially when first starting treatment. Infusion therapies may cause infusion-related reactions. Oral medications each have their own potential side effects, ranging from flushing and stomach upset to more serious but rare complications. Some DMTs, particularly the more potent ones, can increase susceptibility to infections because they suppress immune function.^[10]

Doctors typically recommend staying on a DMT continuously rather than taking breaks, unless side effects or other medical concerns require a change. The benefits of these medications depend on taking them consistently over long periods. Regular monitoring through blood tests, MRI scans, and clinical examinations helps doctors assess whether a treatment is working effectively or whether adjustments might be needed.^[7]

Innovative Treatments Being Tested in Clinical Trials

While current approved treatments have dramatically improved outcomes for people with relapsing MS, researchers continue developing new therapies that might be even more effective or work in different ways. Clinical trials represent the pathway through which these experimental treatments are carefully tested before potentially becoming available to everyone.

Understanding Clinical Trial Phases

Clinical trials follow a structured progression through different phases. Phase I trials are the first tests in humans, usually involving small numbers of participants, and focus primarily on safety—determining whether a new treatment causes unacceptable side effects and finding the right dose range. Phase II trials expand to larger groups and begin evaluating whether the treatment shows signs of effectiveness against the disease while continuing to monitor safety. Phase III trials are large studies comparing the new treatment directly against current standard treatments or placebo to definitively determine whether it works and how it compares to existing options.^[9]

Only treatments that successfully complete all phases and demonstrate both safety and effectiveness can be submitted to regulatory authorities like the Food and Drug Administration for approval. This rigorous process, while time-consuming, helps ensure that new medications are both safe and beneficial before becoming widely available.

Novel Mechanisms Being Explored

Current clinical trials in relapsing multiple sclerosis are investigating several innovative approaches. Many focus on finding more targeted ways to calm down the immune system’s attack on the nervous system while potentially causing fewer side effects than current treatments.

One promising area involves developing new molecules that target specific immune system pathways involved in MS. These might work by blocking particular inflammatory signals or by modulating how immune cells traffic into the brain and spinal cord. By being more selective about which parts of the immune system they affect, these experimental therapies aim to control MS while potentially preserving more normal immune function to fight infections.^[9]

Some trials are exploring whether existing medications approved for other conditions might also help in MS. This approach, called drug repurposing, can potentially speed up the path to approval if the medications are already known to be safe in humans. Researchers are also testing whether combining different types of treatments might be more effective than using single medications alone.

Another research direction involves therapies aimed at promoting repair of damaged myelin, called remyelination. Unlike current DMTs that primarily prevent new damage, these experimental treatments would try to help the body rebuild protective myelin coating that has been destroyed. If successful, such therapies could potentially reverse some of the disability caused by MS rather than just slowing further progression.

Advanced imaging techniques and biomarker research are also being incorporated into clinical trials. These tools help researchers understand more precisely how experimental treatments are affecting the disease process, even before changes might be obvious from symptoms or standard MRI scans. This can help identify which treatments are most promising earlier in the development process.^[9]

Participating in Clinical Trials

Clinical trials are conducted at medical centers and research institutions across the United States, Europe, and worldwide. Patients interested in participating typically need to meet specific eligibility criteria, which might include factors like the type of MS they have, how active their disease is, what treatments they’ve previously used, and their overall health status. Trials often provide the experimental treatment at no cost to participants and may cover some research-related procedures, though this varies by study.^[9]

Participating in a clinical trial offers potential access to new treatments before they’re widely available. It also contributes to advancing medical knowledge that might help future patients. However, there are also considerations like the time commitment for study visits, the possibility of receiving placebo instead of active treatment in some trials, and uncertainty about whether the experimental treatment will work. Discussing clinical trial participation with a neurologist who specializes in MS can help individuals understand whether it might be appropriate for their situation.

Most common treatment methods

• High-dose corticosteroids for acute relapses
  • Methylprednisolone given intravenously at 1 gram daily for three to five days
  • Equivalent high-dose oral prednisone (1250 mg) as an alternative
  • Sometimes followed by oral prednisone taper over one to two weeks
  • Dexamethasone as another intravenous corticosteroid option
  • Reduces inflammation in the central nervous system and shortens relapse duration
• Injectable disease-modifying therapies
  • Interferon beta medications (Avonex, Plegridy) that regulate immune function
  • Glatiramer acetate (Copaxone) that modifies immune responses
  • Given as subcutaneous or intramuscular injections
  • Long-established safety profiles with decades of use
• Oral disease-modifying therapies
  • Various oral medications including dimethyl fumarate, teriflunomide, and fingolimod
  • Convenient pill or capsule form taken at home
  • Each works through different immune system mechanisms
  • Reduce relapse frequency and slow disease progression
• Infusion therapies targeting B cells
  • Ocrelizumab (Ocrevus) given every six months by intravenous infusion
  • Ofatumumab (Kesimpta) that can prevent relapses in approximately 98% of patients when used early
  • Work by depleting B cells that contribute to immune system attacks on myelin
  • Among the most effective treatments currently available
  • Thought to slow disease progression and reduce new brain lesions
• Alternative relapse treatments
  • Adrenocorticotropin hormone preparations (Acthar Gel, Purified Cortrophin Gel)
  • Used for patients who cannot tolerate corticosteroids or don’t respond to them
  • Given as daily injections into muscle tissue
  • Act similarly to corticosteroids in reducing inflammation

Lifestyle Factors That Support Medical Treatment

While medications form the foundation of relapsing MS treatment, several lifestyle factors can meaningfully impact symptoms, relapse frequency, and overall wellbeing. These aren’t replacements for medical treatment but rather important complements to it.

Exercise and Physical Activity

Regular exercise offers multiple benefits for people with relapsing MS. Physical activity strengthens muscles, which helps maintain mobility and balance. It also fights fatigue—one of the most common and frustrating MS symptoms—and improves mood and quality of life. Some research even suggests that strength training might help slow damage in the brain, though more studies are needed to confirm this.^[18]

Exercise recommendations for MS typically include 150 minutes per week of aerobic activities that get the heart pumping, such as walking, swimming, or cycling. Working out at a comfortable, individual pace is important, as is avoiding overheating, which can temporarily worsen symptoms. Daily stretching for at least ten minutes helps release tight muscles and maintain flexibility. Strength training with weights or resistance bands twice weekly helps preserve muscle mass. Physical therapists can design exercise programs tailored to individual abilities and symptoms.^[18]

Nutrition and Diet

A healthy, balanced diet supports overall health and may influence MS symptoms. Research shows that people with MS who eat plenty of fruits, vegetables, and whole grains while limiting processed foods and animal fats tend to experience less disability and fewer symptoms like depression and fatigue compared to those with less healthy eating patterns.^[18]

The Mediterranean diet pattern—rich in fish, vegetables, nuts, and olive oil while low in red meat—has shown benefits for brain and nervous system health. Reducing salt intake may be particularly important, as excess salt can worsen inflammation associated with MS. Getting healthy fats from sources like fatty fish (which provide anti-inflammatory omega-3 fatty acids), nuts, avocados, and olive oil rather than from saturated animal fats may help as well.^[17]

Vitamin D

People with higher blood levels of vitamin D appear to have lower risk of developing MS in the first place, and maintaining adequate vitamin D levels may help reduce relapse risk in those already diagnosed. While research continues, many MS specialists recommend vitamin D supplementation. Good food sources include fatty fish like salmon and trout, egg yolks, and fortified milk and cereals. The body also produces vitamin D from sun exposure, though achieving adequate levels through sunlight alone can be challenging in many climates.^[18]

Avoiding Triggers

Several factors can trigger symptom flare-ups or make existing symptoms temporarily worse. These include heat exposure, which is why many people with MS feel worse in hot weather or after hot baths. Infections, even mild ones like urinary tract infections or sinus infections, commonly cause temporary symptom worsening. Managing stress is important because high stress levels can make symptoms feel more severe. Cigarette smoking not only increases MS risk but can make the disease progress faster, and some medications may not work as well in people who smoke. Getting adequate sleep—seven to eight hours per night—helps the body and brain function optimally.^[3][16]

Living Well With Relapsing Multiple Sclerosis

Beyond medical treatments and healthy habits, several practical strategies help people with relapsing MS maintain quality of life and adapt to changes the disease may bring.

Building Support Systems

Chronic illness affects not just the person diagnosed but their entire support network. Building connections with understanding family members, friends, and others living with MS provides invaluable emotional support. Many people find MS support groups particularly helpful because they offer chances to connect with others facing similar challenges. These groups exist both in-person and online, providing validation, practical tips, and the comfort of knowing you’re not alone in the journey.^[16]

Adapting Activities

As MS symptoms evolve, finding new ways to continue enjoying meaningful activities becomes important. Occupational therapy can teach strategies for performing daily tasks more easily despite physical limitations. Mobility aids like canes, walkers, or wheelchairs aren’t signs of giving up—they’re tools that help conserve energy and maintain independence. At work, many employers can provide reasonable accommodations like flexible schedules for medical appointments or assistive technology. Accepting help from loved ones when needed isn’t weakness; it’s wise resource management.^[16]

Managing Emotional Health

Living with relapsing MS understandably affects mental health. Anxiety and depression are common, and mood problems can actually make physical symptoms feel worse even when the disease itself isn’t progressing. Seeking support for mental health is just as important as treating physical symptoms. This might include counseling, support groups, stress-reduction techniques like meditation or yoga, or medications for anxiety or depression when needed. Maintaining social connections and staying engaged in enjoyable activities helps preserve emotional wellbeing.^[16][17]

Regular Medical Follow-up

Consistent follow-up with healthcare providers allows for monitoring disease activity, adjusting treatments when needed, and addressing new symptoms promptly. This typically includes regular neurological examinations, periodic MRI scans to look for new brain or spinal cord lesions, and blood tests to monitor for medication side effects. Early detection of increasing disease activity allows for treatment adjustments before significant new damage occurs.^[9]