An approach to the use of immunosuppressive drugs in nonmalignant diseases

Immunosuppressive drugs are being given to patients with inflammatory diseases of unknown etiology. The drugs in common use have different biochemical properties that may be responsible for their different immunologic and anti-inflammatory properties. These are reflected in clear-cut distinctions in clinical efficacy. A limited number of controlled trials have suggested that certain immunosuppressive drugs are effective in a few human inflammatory diseases. There have been more negative than positive trials. Furthermore, the drugs increase the risk of infection and may predispose to malignancy. Long-term results are not available; until they are, the drugs would be most profitably administered in the context of controlled long-term trials so that rational approaches to therapy may be possible in the near future. Important medicophilosophical questions are raised by the potential benefit and the potential harm of immunosuppressive drugs in the treatment of nonmalignant diseases. The widespread use of immunosuppressive drugs in the therapy of human diseases of unknown etiology is not warranted at the present time.