Multiple sclerosis. II. A critical assessment of immunotherapy

The profound changes undergone by the immune system in Multiple Sclerosis (MS) suggest that any therapeutic protocol should take immunosuppressive therapy into consideration. The results of the numerous clinical trials should be assessed extremely cautiously in the light of the variable and unpredictable course of MS. Immunosuppressive therapies may act specifically by inhibiting a certain stage in the immune response, or, by contrast, by inducing an overall inhibition of the immune system. Low dosage, aspecific immunosuppressive therapeutic protocols with corticosteroids or azathioprine are used routinely, although there is no sure evidence of their effects. There are, however, unquestionable data on the numerous (and serious) side effects. High dosage, aspecific immunosuppression appears to be better tolerated (probably due to the brevity of the therapies) and to have certain immunodepressant effect within the CNS. ACTH and methylprednisolone are recommended for short-term relapse therapy. Research work on high dosage cyclophosphamide and total lymphoid irradiation is still too limited. Specific immunosuppressive treatment will no doubt be part of future autoimmune disease therapy, but for the time being is no more than theoretically stimulating experimentation (antiidiotypic monoclonal antibodies, specific T cell suppressor factor, T cell "vaccination"). Important multicentric studies on Cyclosporin-A and Copolymer 1 are almost complete once again without reassuring data and with documentation on the numerous side effects as regard to Cyclosporin-A. Clinical trials with Beta-interferon are still in progress and, so far at least, this drug appears to be characterized by the absence of important side effects.