Immunologic therapy for secondary and primary progressive multiple sclerosis |
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Authors: | Lawrence W Myers MD |
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Affiliation: | (1) Multiple Sclerosis Research Center, University of California, Los Angeles, 710 Westwood Plaza, 90095-1769 Los Angeles, CA, USA |
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Abstract: | Multiple sclerosis (MS) is generally considered an immunemediated demyelinating disease, and treatments designed to modify
the course of MS are immunosuppressive or immunomodulatory. Although most people with MS have a relapsing-remitting course
initially, the majority will eventually experience a more gradual decline in neurologic function, termed secondary progressive
MS. Some patients have gradual worsening from the beginning, termed primary progressive MS. Recent pathologic studies have
revealed that axonal injury and neuronal degeneration are much more prominent in MS than previously recognized, and may be
the explanation for the gradual decline in neurologic function that characterizes progressive MS. The results of several clinical
trials in MS indicate that suppression of the immune-mediated inflammation may decrease the relapse rate in MS, but not stop
the progressive loss of neurologic function. There are many promising approaches to this clinical dilemma, but none has been
proven to be effective in stopping or retarding progressive MS. More well-designed, controlled, blinded, randomized clinical
trials are needed to test these putative therapies. In the mean time, we should avoid subjecting patients to potentially dangerous
and unproven regimens. |
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