In MS: Immunosuppression is passé.

Area of Science:

• Immunology
• Neurology
• Pharmacology

Background:

• Multiple sclerosis (MS) treatments often involve prolonged immunosuppression, increasing patient susceptibility to infections and malignancies.
• Immunosuppression impairs immunosurveillance, the immune system's critical function of detecting pathogens and cancerous cells.

Purpose of the Study:

• To evaluate the long-term safety and efficacy of disease-modifying therapies (DMTs) in MS.
• To explore alternative therapeutic strategies that minimize risks associated with prolonged immunosuppression.

Main Methods:

• Defined immunosuppression as a temporary or permanent alteration of immune function impacting pathogen defense.
• Contrasted continuous immunosuppressive agents with immune reconstitution therapies (IRTs), which involve short-term administration followed by sustained immunomodulatory effects.

Main Results:

• IRTs are initially immunosuppressive but become immunomodulatory, offering significant long-term disease activity reduction without continuous retreatment.
• This approach contrasts with traditional immunosuppressive agents requiring ongoing administration.

Conclusions:

• Preserving or modulating immunosurveillance is crucial for selecting optimal MS DMTs.
• For many MS patients, initial immunomodulation followed by IRT for breakthrough disease represents a potentially superior strategy.
• The paradigm of continuous immunosuppression in MS may be outdated.