[Therapeutic indications targeting etiology of progressive multiple sclerosis]

The indication for a long-term treatment in secondary or primary progressive multiple sclerosis is raised in more than half of the patients with MS. The fact that the pathogenic mechanisms involved in these two entities are unknown makes it difficult to predict the clinical course. The still insufficient knowledge of the MRI parameters is another obstacle to overcome. Nevertheless, the results of a certain number of clinical trials have, despite the methodological inadequacies, provided some insight. Immunomodulators, such as interferon-beta, have shown some efficacy, particularly in patients with a still inflammatory form of secondary progressive MS. Massive short-term immunosuppression does not appear to affect the course of progression but prolonged immunosuppression appears to be able to retard progression, at least in certain patients. This points out the importance of starting treatment as early as possible, before the development of irreversible damage. A better analysis of results already published, and most importantly, of results currently under way, should be most helpful in terms of therapeutic management if not in terms of our understanding of the pathophysiological processes involved.