From the Guidelines
For a patient experiencing an acute relapse, increasing the dose of glucocorticoids and/or adding mepolizumab is the recommended treatment approach. This recommendation is based on the most recent evidence from the 2023 guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis 1. The treatment of relapses depends on the type and severity of the relapse, as well as previous treatments and the burden of chronic damage.
Key Considerations
- For systemic and respiratory relapses, increasing the dose of glucocorticoids and/or adding mepolizumab is recommended 1.
- The choice of treatment should be individualized based on the patient's specific situation, including the severity of the relapse and previous treatments.
- For severe systemic relapses, rituximab or cyclophosphamide can be considered as main remission-induction agents 1.
- For non-severe systemic relapses, optimization of glucocorticoid therapy or addition of mepolizumab can be considered 1.
Treatment Approach
- Increasing the dose of glucocorticoids can help to quickly control the relapse symptoms.
- Adding mepolizumab can help to reduce the frequency and severity of relapses.
- The treatment approach should be tailored to the individual patient's needs and response to treatment.
Overall, the goal of treatment is to quickly and effectively control the relapse symptoms, while also considering the potential risks and benefits of different treatment approaches. By following the recommended treatment approach, patients with acute relapses can achieve better outcomes and improved quality of life.
From the Research
Treatment for Acute Relapse
For a patient experiencing an acute relapse, the recommended treatment is typically high-dose intravenous methylprednisolone (MP) given over a period of 3-5 days 2. This treatment has been shown to induce immediate post-treatment and short-term effects on the immune system, which can lead to clinical and radiological improvement in multiple sclerosis (MS) patients.
Dosage and Administration
The optimal dose of methylprednisolone for MS relapses is still uncertain, but studies have compared different dosages. One study found that a lesser high dose of oral methylprednisolone (625 mg/day for 3 days) may not be inferior to the standard high dose (1250 mg/day for 3 days) in terms of clinical and radiological response 3. Another study suggested that intravenous methylprednisolone (1 g daily for 7 days) produces a more rapid clinical improvement than ACTH, but confers no longer-term benefit 4.
Alternative Treatments
In some cases, alternative treatments may be necessary. For example, a case study reported a patient with acute disseminated encephalomyelitis (ADEM) who had an early relapse despite prompt treatment with high-dose methylprednisolone, and the second episode responded to intravenous immunoglobulin (IVIg) 5. Additionally, other studies have investigated the use of plasma exchange, cyclophosphamide, azathioprine, and rituximab for the treatment of renal vasculitis and other conditions 6.
Key Points
- High-dose intravenous methylprednisolone is a common treatment for MS relapses
- The optimal dose and duration of treatment are still uncertain
- Alternative treatments, such as IVIg, may be necessary in some cases
- Plasma exchange and other immunosuppressive agents may be effective for certain conditions 6