title: Role of immunosuppressive therapy for the treatment of multiple sclerosis.
abstract: Immunosuppressives have been used in multiple sclerosis (MS) since 1966. Today, we have many treatments for the relapsing forms of the disease, including 8 US Food and Drug Administration-approved therapies, with more soon to be introduced. Given the current treatment landscape what place do immunosuppressants have in combating MS? Trial work and our experience suggest that immunosuppressives still have an important role in treating MS. Cyclophosphamide finds use in treating patients with severe, inflammatory relapsing remitting MS or those suffering from a fulminant attack. We tend to employ mycophenolate mofetil as an add-on to injectable therapy for patients experiencing breakthrough activity. Some progressive (primary progressive multiple sclerosis or secondary progressive multiple sclerosis) patients may stabilize after treatment with either cyclophosphamide or mycophenolate. We rarely employ mitoxantrone because of potential cardiac or carcinogenic effects. We prefer to use cyclophosphamide or mycophenolate mofetil in preference to methotrexate because evidence of efficacy is limited for this drug. We have less experience with azathioprine, but it may be an alternative for patients with limited options who are unable to tolerate conventional therapies.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Center for Neurologic Disease and Partners MS Center, Harvard Medical School, Boston, MA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Stankiewicz
authors.forename: Hadar
authors.initials: H
authors.lastname: Kolb
authors.forename: Arnon
authors.initials: A
authors.lastname: Karni
authors.forename: Howard L
authors.initials: HL
authors.lastname: Weiner
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008942:Mitoxantrone / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008942:Mitoxantrone; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate