Immunosuppression and Plasmapheresis in Chronic Progressive Multiple Sclerosis

We recently completed a prospective randomized trial of three different immunosuppressive regimens in patients with chronic progressive multiple sclerosis (MS).1The treatments administered were corticotropin, intravenous (IV) high-dosage cyclophosphamide, and plasma exchange. This article reviews the design of the study, focusing on the choice of therapeutic agents, selection of patients, and evaluation of response to treatment. THE THERAPEUTIC PROBLEM Current evidence suggests that MS is an autoimmune disease related in some way to an antecedent viral infection.1,2At present, there is no generally accepted effective therapy. Corticotropin therapy has been shown to accelerate recovery from acute relapses,3although neither it nor corticosteroid therapy seem to modify the long-term course of the disease.4-7 Recently, several uncontrolled studies have suggested that a short course ("pulse") of intensive immunosuppression with cyclophosphamide or other cytotoxic drugs may favorably influence the natural course of active MS. Hommes and colleagues8