Double-Blind, Controlled Trial of Immunosuppression in Treatment of Multiple Sclerosis

Mertin, J.; Knight, S. C.; Rudge, Peter; Thompson, E J; Healy, M.

doi:10.1016/s0140-6736(80)92107-8

Cited by 26 publications

(6 citation statements)

References 8 publications

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“…2b). Our study was designed to assess in a randomized allocation, but unblinded clinical evaluation, the long term efficacy of CYA, a new immunosuppressive drug in the treatment of MS. Because AZA has been shown to be beneficial in the treatment of MS [1][2][3] and is a drug used in our centers for many years, we did not believe that it was feasible to randomize patients with active disease to receive no treatment. Our study, therefore, does not contain a placebo group.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Cyclosporine versus Azathioprine in the Treatment of Multiple Sclerosis: 12-Month Clinical and Immunological Evaluation

Steck¹,

Régli²,

Ochsner³

et al. 1990

Eur Neurol

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The aim of this trial was to compare the efficacy and tolerance of cyclosporine A (CYA) and azathioprine (AZA) as long-term immunosuppressive treatment for patients with multiple sclerosis. 31 randomly assigned patients completed a 12-month treatment with either CYA (5 mg/kg/day) or AZA (2 mg/kg/day). Evaluation included serial quantitative clinical assessments and circulating T cell markers. The CYA treatment group improved in only one of three scoring systems (p < 0.05), while no difference was observed in the AZA group. CYA and AZA did not influence CD4+/CD8+ ratio of circulating T cells but affected HNK-1+ cells. The overall frequency of abnormal laboratory values were comparable in both groups. We conclude that CYA given in a low dose is relatively well tolerated but its benefits appear to be of limited value.

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Section: Resultsmentioning

confidence: 99%

“…Azathioprine (AZA) has been used for over 20 years as an immunosuppressive drug in multiple sclerosis (MS) and a large number of clinical trials has been car ried out [1][2][3]. AZA is a purine antagonist and its pri mary effects are directed against actively replicating cells.…”

Section: Introductionmentioning

confidence: 99%

Cyclosporine versus Azathioprine in the Treatment of Multiple Sclerosis: 12-Month Clinical and Immunological Evaluation

Steck¹,

Régli²,

Ochsner³

et al. 1990

Eur Neurol

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“…In MS, ATG has failed consistently to amelio rate the clinical course although side effects were usually mild [29], Recent trials have revealed a beneficial effect of cyclosporine in MS [30], Blood cell production in this patient was initially cyclosporine-dependent. A varying degree of cyclosporine dependency in many SAA patients has been reported [20],…”

Section: Discussionmentioning

confidence: 99%

Coincidence of Severe Aplastic Anaemia with Multiple Sclerosis or Thyroid Disorders

Hinterberger-Fischer¹,

Kier²,

Forstinger³

et al. 1994

Acta Haematol

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Five patients with severe aplastic anaemia (SAA) who, simultaneously (n = 3) or consecutively (n = 2), presented with multiple sclerosis (MS) (n = 2) or immune hyperthyroidism (IHT) (n = 2) or subacute thyroiditis (n = 1) are described. Two female patients with MS developed SAA after a small dose of azathioprine. Another patient simultaneously presented with IHT and SAA. SAA and MS responded to cyclosporine while IHT required ¹³¹I. Relapsing SAA in 1 patient with MS was treated with antithymocyte globulin (ATG) which induced acute exacerbation of MS. Despite the low total dose of ATG (31.5 mg/kg), complete remission of SAA was obtained. Two other patients developed thyroid disorders, 42 and 106 months after successful immunosuppression with ATG/high-dose methylprednisolone. IHT and subacute thyroiditis were successfully treated with ¹³¹I or prednisolone, respectively, without recurrence of SAA in both cases. These are the first documented cases of SAA evolving in the course of MS while the coincidence with IHT was already described. Since enhanced expression of interferon-γ plays a crucial role in SAA as well as in MS and in IHT, similar pathogenetic principles may apply for these seemingly unrelated disorders.

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“…The second explanation is also improbable, since in clinical trials, the use of levamisole as a treatment for multiple sclerosis has not exacerbated the underlying disease. 29 The third explanation, which is the most plausible, suggests that levamisole or fluorouracil stimulates a destructive immune response to a novel antigen that is persistent but does not cause symptoms, resulting in demyelination in susceptible persons.…”

Section: Differential Diagnosismentioning

confidence: 99%

Case 24-1999

Recht¹,

Primavera²

1999

N Engl J Med

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Double-Blind, Controlled Trial of Immunosuppression in Treatment of Multiple Sclerosis

Cited by 26 publications

References 8 publications

Cyclosporine versus Azathioprine in the Treatment of Multiple Sclerosis: 12-Month Clinical and Immunological Evaluation

Cyclosporine versus Azathioprine in the Treatment of Multiple Sclerosis: 12-Month Clinical and Immunological Evaluation

Coincidence of Severe Aplastic Anaemia with Multiple Sclerosis or Thyroid Disorders

Case 24-1999

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