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In SPMS, characterized by steady deterioration without acute attacks, treatment strategies often involve continuing or altering DMT used during the earlier RRMS phase, such as interferon beta, or considering immune-modulating agents, such as methotrexate, cyclophosphamide, or glucocorticoid pulses [142, 143]

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8 weeks (11 vials): 33 mL 4 10 mL bottles 12 weeks (17 vials): 51 mL 6 10 mL bottles 16 weeks (22 vials): 66 mL 7 10 mL bottles Alcohol Swabs: One for the vial stopper + one for the injection site each day

Regular tests for bacteria are a must