Zaffaroni M, Ghezzi A, Comi G
Centro Studi Sclerosi Multipla, Az. Osp. S. Antonio Abate, Via Pastori 4, I-21013 Gallarate (VA), Italy.
Neurol Sci. 2006 Mar;27 Suppl 1:S13-7. doi: 10.1007/s10072-006-0539-5.
Immunosuppressive drugs have been used out of label in multiple sclerosis (MS) for over 30 years and around 10% of patients are actually under immunosuppressive treatment. The rationale for immunosuppression in MS lies in the hypothesis that MS is an inflammatory immune-mediated disease that can take advantage of strong anti-inflammatory activity. Azathioprine, methotrexate, cyclophosphamide and mitoxantrone are the most utilised agents, but only the latter has been approved for clinically active MS. Many of them are safe in combination with interferon-beta and are under investigation in controlled trials. Plasma exchange is limited to catastrophic attacks in refractory MS whilst bone marrow transplantation is considered in patients with an extremely severe, active disease as the final option in escalation therapy. Although immunosuppressants are best effective in induction therapy, their use is limited by toxicity and potential long-term risk.
免疫抑制药物在多发性硬化症（MS）中的超适应证使用已有30多年，约10%的患者实际上正在接受免疫抑制治疗。MS免疫抑制的理论依据在于这样一种假说，即MS是一种炎症性免疫介导疾病，可借助强大的抗炎活性。硫唑嘌呤、甲氨蝶呤、环磷酰胺和米托蒽醌是最常用的药物，但只有后者已被批准用于临床活动性MS。它们中的许多与β-干扰素联合使用是安全的，并且正在对照试验中进行研究。血浆置换仅限于难治性MS的灾难性发作，而骨髓移植则被考虑用于患有极其严重的活动性疾病的患者，作为强化治疗的最终选择。尽管免疫抑制剂在诱导治疗中效果最佳，但其使用受到毒性和潜在长期风险的限制。
