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Immunotherapy in multiple sclerosis, Part 1

C C Becker1, B E Gidal, J O Fleming

  • 1Department of Pharmacy, St. Francis Hospital, Milwaukee, WI 53215, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|September 15, 1995
PubMed
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This review examines immunotherapies for multiple sclerosis (MS), an inflammatory CNS disease. While some treatments like corticosteroids and interferon beta-1b can manage relapses, none reverse disease progression, and some have serious side effects.

Area of Science:

  • Neuroimmunology
  • Pharmacology

Background:

  • Multiple Sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS) affecting young adults.
  • Immunologic mechanisms are implicated in MS, suggesting the utility of immunomodulating therapies.
  • Therapeutic goals in MS management include improving recovery, reducing relapse frequency/severity, and slowing disease progression.

Purpose of the Study:

  • To review the efficacy of various immunotherapies for multiple sclerosis.
  • To assess the benefits and risks of corticosteroids, azathioprine, cyclophosphamide, immune globulin, cyclosporine, interferons, copolymer 1, and cladribine in MS patients.

Main Methods:

  • Systematic review of clinical trial data on immunotherapeutic agents for multiple sclerosis.
  • Analysis of drug efficacies based on clinical outcomes such as exacerbation recovery, relapse rates, and disease progression.

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Main Results:

  • Corticosteroids and corticotropin accelerate recovery from exacerbations; long-term use is not recommended for disease modification.
  • Azathioprine offers modest benefits for relapse rates but is not advised for aggressive MS. Cyclophosphamide has limited efficacy and significant risks, reserved for severe cases.
  • Interferon beta-1b reduces relapse frequency and severity in relapsing-remitting MS. Intravenous immune globulin and cyclosporine show limited proven efficacy or significant adverse effects.
  • Copolymer 1 and cladribine show promising early results, but none of the reviewed therapies can reverse MS progression.

Conclusions:

  • Current immunotherapies for MS can provide symptomatic relief and manage relapses but do not halt disease progression.
  • Some treatments carry substantial risks, including severe adverse effects and potential for cancer.
  • Further understanding of MS immunopathogenesis is needed to develop more specific and effective long-term therapies.