High dose methylprednisolone is usually the initial treatment of acute transverse myelitis
, (although only Class IV evidence supports this practice, which constitutes "insufficient evidence"). Similarly, "insufficient evidence" supports mitoxantrone
. Plasma exchange is "possibly" useful based on 1 Class II study, and rituximab "possibly" effective based on 2 Class III studies. "Insufficient evidence" supports azathioprine
, and IVIg to alleviate symptoms or prevent future attacks.