Advances in specific therapy for multiple sclerosis.

Abstract

During the past year, two new agents have been demonstrated to be of value in multiple sclerosis. The first agent, a form of recombinant interferon beta (Betaseron; Berlex Labs, Cedar Knolls, NJ), is effective in reducing relapses and also prevent accumulation of brain lesions over time, but has no demonstrated effect on the accumulation of disability over time. The second agent, methylprednisolone (Solumedrol; The Upjohn Co., Kalamozoo, MI), administered in megadose pulses over several days and followed by an oral prednisone taper, reduces the conversion rate of patients with optic neuritis to multiple sclerosis by approximately 50% over 2 years compared with placebo or oral prednisone alone. The mechanisms by which these agents exert their benefits are incompletely understood, but both have complex, relatively widespread effects on the immune systems. The demonstration of efficacy for both of these agents represent landmarks in the search for an effective treatment for multiple sclerosis; both agents seem to provide prophylaxis against future relapses, and methylprednisolone seems to delay the development of the disease. Their introduction into the clinical environment will undoubtedly have a profound effect on the day-to-day care of multiple sclerosis patients as well as the designs of future basic and clinical research. Other new therapies that have substantial potential for benefit in multiple sclerosis but require further definitive study include intramuscular copolymer 1 for relapsing disease and low-dose oral methotrexate and booster doses of intravenous cyclophosphamide for chronic progressive disease.