Intensive immunosuppression in multiple sclerosis

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• 作者：M. Zaffaroni ; A. Ghezzi and G. Comi
• 关键词：Key words Immunosuppressive drugs ; Induction therapy ; Escalation therapy ; Combined therapy ; Rescue therapy ; Multiple sclerosis
• 刊名：Neurological Sciences
• 出版年：2006
• 出版时间：March 2006
• 年：2006
• 卷：27
• 期：0
• 页码：s13-s17
• 全文大小：45 KB

文摘

Immunosuppressive drugs have been used out of label in multiple sclerosis (MS) for over 30 years and around 10 % of patients are actually under immunosuppressive treatment. The rationale for immunosuppression in MS lies in the hypothesis that MS is an inflammatory immune-mediated disease that can take advantage of strong anti-inflammatory activity. Azathioprine, methotrexate, cyclophosphamide and mitoxantrone are the most utilised agents, but only the latter has been approved for clinically active MS. Many of them are safe in combination with interferon-β and are under investigation in controlled trials. Plasma exchange is limited to catastrophic attacks in refractory MS whilst bone marrow transplantation is considered in patients with an extremely severe, active disease as the final option in escalation therapy. Although immunosuppressants are best effective in induction therapy, their use is limited by toxicity and potential long-term risk.