[Immunosuppressive medication in multiple sclerosis]

Immunosuppressive drugs have been used for decades in the treatment of multiple sclerosis. The recent availability of immunomodulators has caused a major change in the treatment of this disease, but has not meant the disappearance of the use of immunosuppressive drugs, some of which (such as mitoxantrone) have been introduced recently. At present, it is difficult to assess the precise indications for these drugs, since most efficacy studies were made before the availability of magnetic resonance imaging, on criteria which are now considered obsolete. Independently of their value in monotherapy, immunosuppressants may probably be useful in combination with immunomodulators. We review the experience with the most widely used immunosuppressants and mention those drugs which might be used in the near future.