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October 1983

Immunosuppression and Plasmapheresis in Chronic Progressive Multiple Sclerosis: Design of a Clinical Trial

Author Affiliations

From the Multiple Sclerosis Clinical and Research Unit, Department of Medicine, Division of Neurology, Brigham & Women's Hospital (Drs Hauser, Dawson, and Weiner); the Department of Neuroscience (Drs Hauser and Weiner) and Transfusion Service (Dr Kevy), Children's Hospital Medical Center; and the Department of Neurology, Massachusetts General Hospital (Drs Lehrich and Beal), Boston.

Arch Neurol. 1983;40(11):687-690. doi:10.1001/archneur.1983.04050100027009

We recently completed a prospective randomized trial of three different immunosuppressive regimens in patients with chronic progressive multiple sclerosis (MS).1 The 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.1,2 At present, there is no generally accepted effective therapy. Corticotropin therapy has been shown to accelerate recovery from acute relapses,3 although neither it nor corticosteroid therapy seem to modify the long-term course of the disease.4-7Recently, 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

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