Durelli L
Istituto di Clinica delle Malattie del Sistema Nervoso Università di Torino, Italy.
Acta Neurol (Napoli). 1991 Oct;13(5):467-75.
Immunosuppressive therapy may act specifically by inhibiting a certain stage of the immune response, or, by contrast, by inducing an overall inhibition of the immune system. Low dosage, a specific immunosuppressive therapeutic protocols with corticosteroids or azathioprine are used routinely, although there is no evidence of their effects. There are, however, unquestionable data on the numerous (and serious) side effects. High dosage, a specific immunosuppression appears to be better tolerated (probably due to the brevity of the treatment) and to have certain immunodepressant effects within the CNS. ACTH and methylprednisolone are recommended for short-term relapse therapy. Specific immunosuppressive treatment will no doubt be part of future autoimmune disease therapy, but for the time being is no more than theoretically stimulating experimentation (anti-idiotypic monoclonal antibodies, specific T cell suppressor factor, T cell "vaccination"). Important multicentric studies on cyclosporin-A and copolymer 1 are almost complete on the numerous side effects as regard to cyclosporin-A. Clinical trials with alpha or beta-interferons are still in progress and, so far at least, these drugs appear to be characterized by the absence of important side effects.
免疫抑制疗法可能通过抑制免疫反应的某个特定阶段而发挥特异性作用,或者相反,通过诱导免疫系统的全面抑制来起作用。低剂量时,通常使用皮质类固醇或硫唑嘌呤的特定免疫抑制治疗方案,尽管尚无其疗效的证据。然而,关于众多(且严重)副作用的数据是确凿无疑的。高剂量时,特定的免疫抑制似乎耐受性更好(可能由于治疗时间较短),并且在中枢神经系统内具有一定的免疫抑制作用。促肾上腺皮质激素和甲基强的松龙推荐用于短期复发治疗。特定的免疫抑制治疗无疑将成为未来自身免疫性疾病治疗的一部分,但目前不过是理论上激发实验(抗独特型单克隆抗体、特异性T细胞抑制因子、T细胞“疫苗接种”)。关于环孢素A和共聚体1的重要多中心研究几乎已完成,涉及环孢素A的众多副作用。α或β干扰素的临床试验仍在进行中,至少到目前为止,这些药物似乎具有无重要副作用的特点。
Acta Neurol (Napoli). 1991-10
Riv Neurol. 1989
Neurol Clin. 1990-2
Rev Neurol (Paris). 1998-9
Ann Neurol. 1988-3
Pathol Biol (Paris). 2000-3
Ugeskr Laeger. 1994-10-24
Neurology. 1988-7
Nat Clin Pract Neurol. 2006-4