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November 1988

Is Steroid Therapy in Multiple Sclerosis Superior to Corticotropin Therapy?

Author Affiliations

Multiple Sclerosis Center Rush-Presbyterian-St Luke's Medical Center 1725 W Harrison St Chicago, IL 60612

Arch Neurol. 1988;45(11):1180. doi:10.1001/archneur.1988.00520350018004

To the Editor.  —We read the special article "Steroid Therapy in Multiple Sclerosis" by Troiano et al1 in the August 1987 issue of the Archives with interest. While we agree that high-dose corticosteroid therapy has a role in the treatment of acute exacerbations in multiple sclerosis (MS), it is unclear if this is superior to corticotropin therapy. Though not stating an unequivocal preference, the authors' point of view is more favorable to corticosteroid treatment. In their comparisons, they focus largely on the adrenal-stimulating action of corticotropin and assume the long-held notion that corticotropin treatment can be considered an indirect way of administering corticosteroids. However, recent studies indicate a more complex situation.Corticotropin has been shown to directly regulate antibody responses2 and also to potently suppress interferon gamma production in mouse spleen cell cultures.3 The latter effect is particularly noteworthy, in view of the recent demonstration that treatment

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