ACTH in Progressive Forms of MS

Inclusion Criteria:

- Male or female patients with a confirmed diagnosis of MS by McDonald criteria

- Age >/= 18 years

- SPMS, PPMS, or PRMS phenotype, according to Lublin and Reingold criteria

- EDSS 2.0 - 6.0, inclusive

- Able to understand the consent process

Exclusion Criteria:

- Known intolerance of ACTH or corticosteroids

- Diabetes mellitus, defined as pre-existing diagnosis, fasting blood glucose > 125
mg/dl, or glycosylated hemoglobin >/= 6.5%

- Osteoporosis, defined as pre-existing diagnosis or T-score on dual-energy x-ray
absorptiometry (DEXA) scan of
- Current serious medical condition which may interfere with subject's ability to
complete the study, or for which pulsed ACTH therapy is contraindicated or might
complicate current therapy (e.g., cancer, severe psychiatric illness, chronic
infections, autoimmune disorders)

- Treatment with cytotoxic agents (including but not necessarily limited to
mitoxantrone, cyclophosphamide, alemtuzumab, or rituximab) within 3 years prior to
randomization

- Treatment with non-cytotoxic immunosuppressive agents (including but not necessarily
limited to corticosteroids, ACTH, azathioprine, mycophenolate mofetil, methotrexate or
natalizumab) within 3 months prior to randomization

- Treatment with FDA-approved first-line MS disease-modifying therapies (B-interferon,
glatiramer acetate, fingolimod, teriflunomide or dimethyl fumarate) will be permitted,
as long as treatment has been ongoing and stable for at least 3 months prior to
randomization

- Treatment with dalfampridine or compounded 4-aminopyridine (4-AP) will be permitted as
long as treatment has been ongoing and stable for at least 3 months prior to
randomization

- Stimulant medications for fatigue (such as methylphenidate, modafinil, armodafinil,
amantadine or dextroamphetamine) will be permitted, but subjects will be asked to not
take these medications on study visit days until all study procedures/assessments are
completed.